The popliteal artery is seen as a pulsating anechoic structure in the center of the scan.
At this level, the femoral condyles appear as discontinuous, curved hyper-echoic lines. The probe is placed transversely at or just above the popliteal crease to visualize the femoral condyles and the popliteal artery in cross-section (Figure 3). Another advantage of the curvilinear probe is the wide scanning view. With the patient in a prone position, a high frequency linear probe or the low frequency curvilinear transducer can be used depending on body habitus. Even though we have since transitioned to performing the iPACK in a supine position, it is still worthwhile to review the original injection technique to get a better understanding of the sonoanatomy and procedure. When we conceived the concept of iPACK, our injections were performed with the patient in a prone position. We introduced the iPACK technique at the American Society of Regional Anesthesia (ASRA), Spring meeting in 2012. The goal of iPACK is to selectively block only the innervation of the posterior knee joint while sparing the main trunks of tibial and common peroneal nerves, thereby, maintaining the sensorimotor function of the leg/foot. These articular branches can be blocked by infiltrating this tissue plane between the popliteal artery and the capsule of the knee (iPACK) with local anesthetic solution under ultrasound guidance. The articular branches, after arising from the main trunks of the tibial and obturator nerves, travel through a tissue space between the popliteal artery and the femur to innervate the posterior capsule of the knee (Figure 2). The goal of iPACK is to selectively block only the innervation of the posterior knee joint while sparing the main trunks of tibial and common peroneal nerves, thereby maintaining the sensorimotor function of the leg and foot. A selective tibial nerve block in the popliteal fossa is an alternative to sciatic nerve block and can provide analgesia without causing a foot drop, but it decreases sensory perception in the sole of the foot and causes weakness of plantar flexion. Posterior knee pain can be controlled by sciatic nerve block, but leads to undesirable foot drop and may delay diagnosis and treatment of surgically induced common peroneal nerve injury. This pain is mediated by articular branches that originate primarily from the tibial component of the sciatic nerve with contributions from the obturator nerve (Figure 1). Contact us to find out what technology and know-how is used to obtaining our ambitious goals that can help you achieving your sustainable and economical targets as well.Controlling posterior knee pain after total knee arthroplasty is an important component of the comprehensive strategy for providing postoperative analgesia. Everything IPack takes back from its customer and market is reused, recycled, regenerated or gets a second life. Today we can proudly say IPack manages to contribute in a sustainable way to a healthier and cleaner environment by generating a closed loop for plastics and steel packaging. It is actually our passion for these industrial packaging that made us put together the puzzle through our business network and packaging production know-how. In some countries IPack is providing directly its own sustainable services and producing packaging in its own facilities and in some areas IPack works together with exclusive partners that share the same business philosophy. IPack is managed by people with more than15 years of experience in average in the industrial packaging market and has presence all over Europe. The fact that plastics, steel and other industrial packaging are put in a negative day light because of its polluting character helped us creating a network of business people and production solutions to reducing the environmental impact of these industrial packaging. IPack stands for the Integration of industrial packaging in today's environment.
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