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iPACK Block

Anatomy

The iPACK block stands for "Injection between the Popliteal Artery and posterior Compartment of the Knee"  and provides a sensory block specifically to the posterior aspect of the knee. The anterior aspect of the knee is commonly covered by an entirely different nerve block such as the adductor canal block or femoral nerve block. The iPACK block targets the posterior genicular innervation of the knee. The posterior genicular nerves consist of  articular branches of the common peroneal, tibial and obturator

nerves. These nerves provide mostly sensory innervation to the knee posteriorly. The absence of significant motor block is the reason for choosing the iPACK over the popliteal sciatic nerve block. Simply stated, patients can undergo physical therapy sooner with an iPACK block. As seen in image 1 the medial and lateral head of the gastrocnemius muscle, the sartorius muscle, biceps muscle along with the femoral condyles may all be visualized during the block.

image 1

Block Procedure

The ultrasound guided iPACK block is performed with the patient positioned supine, hip abducted and the knee flexed. The ultrasound probe is positioned posteriorly slightly proximal to the flexion line of the knee (image 2). A curvilinear or linear probe may be used to perform the block using  an inplane

technique. The needle is inserted medial and directed to the space between the popliteal artery and lateral condyle of the knee. If using a linear probe it will need to be moved in order to visualize the needle as it is advanced to the target in a medial to lateral approach while a curvilinear probe may visualize all necessary structures including the approach of the block needle and spread of local anesthetic without being repositioned (image 3 and image 4). Ultrasound visualization during injection should show spread of local anesthetic from the lateral to medial condyle between the popliteal artery and condyles (image 5). A potential "genicular space" has been described which when entered with the block needle allows for adequate spread of local anesthetic without repositioning.  a paragraph. Click here to add your own text and edit me. It's easy.

image 2

image 4

image 3

image 5

Every effort has been made to ensure the accuracy of the information presented within this website. The information presented does not constitute medical advice. Permission was given by Dr. Vicente Roques Escolar to use images from the ipack block video posted here: https://www.youtube.com/watch?v=6A_kJTQrczk