Have the patient in the prone position.This distribution makes it clear that if adequately blocked, the terminal sensory branches of the tibial nerve should significantly decrease posterior knee pain without potentially masking a peroneal nerve injury. It is the posterior articular nerve of the tibial nerve that crosses the posterior capsule at the level of the oblique popliteal ligament and supplies the capsule and meniscal synovial junction, cruciate ligaments and the infrapatellar fat pad. Here, only the terminal sensory branches of the tibial nerve innervate the posterior knee joint. I augment each of my blocks with an "iPACK" (infiltration between popliteal artery and capsule of knee) block and have seen a significant reduction in post-op posterior pain.Īs the name suggests, the local anesthetic is placed between the posterior capsule of the knee and the popliteal artery. Thankfully, a new regional technique with a catchy name has proven to effectively control posterior knee pain. Blocking the sciatic nerve, which is what provides innervation to the posterior of the knee, is dangerous, because it may cause foot drop and thus mask a surgically induced peroneal nerve injury caused during surgery. ![]() Femoral nerve blocks cover the femoral nerve and adductor canal blocks cover the saphenous nerve. ![]() Pain relief following knee replacement surgery has typically been concentrated in the anteromedial aspects of the knee, with little relief for the posterior. The new nerve block may provide an effective option for controlling posterior knee pain following knee replacement surgery. The "iPACK" is an ultrasound-guided infiltration of the interspace between the popliteal artery and the capsule of the knee with a local anesthetic solution that provides an alternative analgesic when combined with a femoral nerve block. ON TARGET The goal of an "iPACK" block is to insert the block needle in a medial to lateral direction between the popliteal artery and the femur.
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