2021년도 제72차 대한통증학회 학술대회 및 연수교육

A 71-year-old female patient visited our pain center complaining of subacute right posterior knee joint pain. A month before visiting our clinic, she felt a stinging pain in her popliteal area while fast-paced walking, and posterior knee joint pain continued since then. The Patient’s X-ray revealed Kellgren-Lawrence (K-L) grade 2 osteoarthritis in both knee joints. The patient had an initial numeric rating score (NRS) of 6, a Western Ontario and McMaster Universities Arthritis Index (WOMAC) of 40, and an EQ-5D score of 12. Despite prescribing medications such as celecoxib (200 mg, Celebrex) and Clematidis Radix(200 mg, Joins) once daily and educating the patient on exercise training, the patient’s symptoms did not improve. We administered an ultrasound-guided iPACK block at the level of the ABTN in accordance with the technique previously described by Kampitak et al. The patient was placed in the prone position and subjected to high-frequency linear ultrasound. The probe was moved in cranial to caudal direction until two heads of the gastrocnemius muscle were visualized. The needle was inserted from the lateral to medial direction. After locating the popliteal plexus under the popliteal artery, 2 ml of 0.4% lidocaine was injected. A second injection was administered in the same pattern between the popliteal artery and the femoral condyle. Five minutes after the procedure, the patient’s motor strength in dorsiflexion and plantar flexion was evaluated together with the dermatomal sensation of tibial and common peroneal nerves. The patient had no immediate complications of motor weakness or loss of sensation.
One month after the procedure, the patient returned to our clinic and reported decreased pain in the posterior knee joint. The patient’s NRS improved from 6 to 1-2, WOMAC improved from 40 to 12, and EQ-5D improved from 12 to 4. At the time of writing this report, five months after the procedure, the patient was well maintaining improved health and had no pain.

This is the first report of successful control of chronic popliteal pain in knee OA patients with iPACK block.