![]() If you do opt to do a combined approach, where the surgeon typically uses large volumes of local anesthesia, your best bet is to use a relatively low volume for your iPACK and AC (as you are doing with 20ml and 12ml, respectively) and use a low concentration local anesthetic (I would consider using 0.2% ropivacaine with dexamethasone as opposed to 0.5% for your AC). Value of IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block in total knee arthroplasty: Article 3, Volume 2, Issue 1, January 2021, -18 PDF (499.98 K) Document Type: Original Article: DOI: 10.21608/aimj.2021.55090. There is always going to be some degree of toxicity (and medicolegal) risk combining blocks with local anesthesia infiltration (both standard LA and liposomal LA). 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. This is especially true since your blocks and their infiltration are likely separated in time. 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. Your total dose does seem reasonable assuming your Exparel dose is 20ml (i.e. This is a very common question: is it OK to do nerve blocks in addition to infiltration with liposomal bupivacaine? The short answer is that we don't know for certain and many anesthesiologists avoid this combination out of fear for toxicity.
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