Date of this Version


Document Type

DNP Project


Background. Orthopedic arthroplasty surgeries are one of the most performed surgical procedures in the United States, with over 840,000 total knee replacement patient admissions in 2017.1 The quality improvement display will exhibit that the utilization of the IPACK block should be regularly applied to improve postoperative knee pain in combination with the ACB to enhance pain relief, increase mobility, decrease hospital stay, and reduce opioid consumption along with opioid side effects such as nausea and vomiting.

Methods. The databases utilized for the search included The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Google Scholar. library, with full-text availability. Exclusion criteria included the studies that were published more than 10 years ago, comparison with other peripheral nerve blocks such as sciatic or femoral, abstract only, inaccessible, or thirdparty accessible articles. Other terms utilized during the search was peripheral nerve block and TKA. The Boolean phrases were utilized and produced 116 articles. Ten articles were chosen for review based on the inclusion and exclusion criteria, and 8 were utilized.

Conclusion and Discussion. All TKA patients should receive the ACB and IPACK block perioperatively to decrease opioid consumption, side effects of pain, pain scores, and hospital stay and increase mobility. The IPACK block is a technique that relieves pain on the posterior portion on the knee, which is vulnerable to pain when utilizing the ACB alone.2 The ACB provides a sensory block solely to the anterior and lateral portions of the knee.2 By utilizing both blocks for TKA patients, all areas of the knee are receiving an adequate sensory blockade. The IPACK should be routinely utilized in all TKA surgical patients to provide better patient outcomes.