Purpose In recent years, there has been an increasing interest in local infiltration analgesia (LIA) as a technique to control postoperative pain. We compared this technique to the gold standard the 3 in 1 femoral nerve block (FNB) in postoperative pain management after total knee arthroplasty (TKA) in a large patient population. This trial analyzes in the early postoperative phase the pain, range of motion, and consumption of pain medications after TKA. Methods We conducted a retrospective trial that included all patients who were undergoing primary TKA by one single surgeon in a high-volume arthroplasty center in 2015. Patients who have secondary osteoarthritis due to rheumatoid arthritis or previous knee arthrotomy, as well as revision cases, were excluded. The included patients were divided into 2 groups according to the applied pain management (group 1 FNB, group 2 LIA). Concerning the LIA group, a modified form of composition compared to the first describer without the use of adrenaline was carried out. Post-operative additional pain medications were given on a fixed scheme to the patient. The primary outcome was pain at rest over 7 days after surgery labeled by the numeric pain rating scale (NRS). The secondary outcome measures were the total amount of opioid consumption over the hospital stay and the additional need for non-opioid medication. The conversion of the opiate medications on the morphine preparation was carried out according to the conversion data from the literature. For functional recovery, we compared the range of motion in both groups, which was recorded from the second postoperative day by the attending physiotherapist. Results In total, 202 patients were assessed for eligibility and included in this clinical trial. Hundred patients were allocated to the continuous FNB group (group 1) and 102 patients to the LIA group (group 2). No statistical difference was found between the two groups regarding demographic data. Primary outcome measurements: The LIA group had a significantly lower NRS score than the continuous FNB group for the measurement in the morning on days 1, 2, and 3 after surgery (day 1, 1.5; day 2, 1.6; day 3, 1.3; p < 0.05). Secondary outcome measurements: The total volume of morphine consumption for the first six postoperative days was significantly lower in the LIA group than the FNB group (FNB 159.8 vs. LIA 96.07). There is also a significant difference between the total morphine consumption of both groups in the direct postoperative course with respect to time and group (two way ANOVA, p < 0.05) On the day of the operation and on the first postoperative day, the intake of additional non-opioids in the LIA group was also significantly reduced compared to the FNB group. No significant difference was observed on the second to sixth postoperative day concerning an additional consumption of non-opioid medications. In terms of range of motion, the LIA group showed a higher active range of motion at the operated extremity than the FNB group during the hospital stay. Conclusion The local intraarticular infiltration therapy (LIA) is a sufficient alternative to regional anesthesia avoiding the known risks of regional procedures. The results of this study reflect the efficiency of this pain management with a lower consumption of analgesics, identical to reduced postoperative pain ratings and an improved ROM in the first postoperative days. Level of evidence Retrospective trial

Purpose In recent years, there has been an increasing interest in local infiltration analgesia (LIA) as a technique to control postoperative pain. We compared this technique to the gold standard the 3 in 1 femoral nerve block (FNB) in postoperative pain management after total knee arthroplasty (TKA) in a large patient population. This trial analyzes in the early postoperative phase the pain, range of motion and consumption of pain medications after TKA. Methods We conducted a retrospective trial that included all patients who were undergoing primary TKA by one single surgeon in a high-volume arthroplasty center in 2015. Patients who have secondary osteoarthritis due to rheumatoid arthritis or previous knee arthrotomy, as well as revision cases were excluded. The included patients were divided into 2 groups according to the applied pain management (group 1= FNB, group 2 = LIA). Concerning the LIA group a modified form of composition compared to the first describer without the use of adrenaline was carried out. Post-operative additional pain medications were given on a fixed scheme to the patient. The primary outcome was pain at rest over 7 days after surgery labeled by the numeric pain rating scale (NSR). The secondary outcome measures were the total amount of opioid consumption over the hospital stay and the additional need for non-opioid medication. The conversation of the opiate medications on the morphine preparation was carried out according to the conversion data from the literature. For functional recovery, we compared the range of motion in both groups, which was recorded from the second postoperative day by the attending physiotherapist. Results In total 202 patients were assessed for eligibility and included in this clinical trail. Hundred patients were allocated to the continuous FNB group (group 1) and 102 patients to the LIA group (group 2). No statistical difference was found between the two groups regarding demographic data. Primary outcome measurements: The LIA group had a significantly lower NRS score than the continuous FNB group for the measurement in the morning on day 1,2 and 3 after surgery (d1: 1,5, d2: 1,6, d3: 1,3 p<0,05). Secondary outcome measurements: The total volume of morphine consumption for the first six postoperative days was significantly lower in the LIA group than the FNB group (FNB: 159,8 vs. LIA: 96,07). There is also a significant difference between the total morphine consumption of both groups in the direct postoperative course with respect to time and group (two way Anova, p<0,05) On the day of the operation and on the first postoperative day, the intake of additional non-opiods in the LIA group was also significantly reduced compared to the FNB group. No significant difference was observed on the second to sixth postoperative day concerning an additional consumption of non-opioid medications. In terms of range of motion the LIA group showed a higher active range of motion at the operated extremity than the FNB group during the hospital stay. Conclusion The local intraarticular infiltration therapy (LIA) is a sufficient alternative to regional anesthesia avoiding the known risks of regional procedures. The results of this study reflect the efficiency of this pain management with a lower consumption of analgesics, identical to reduced postoperative pain ratings and an improved ROM in the first postoperative days.

Aims and Objectives: In recent years, there has been an increasing interest in local infiltration analgesia (LIA) as a technique to control postoperative pain. We compared this technique to the gold standard using the 3 in 1 nerve block in postoperative pain management after total knee arthroplasty (TKA). This trial analyzed pain, range of motion and consumption of pain medications after TKA in the early postoperative phase. Materials and Methods: We conducted a retrospective trial by analyzing the data of 202 patients, which were separated in two groups. Group 1 treated by 3-in-1 femoral nerve block included 100 patients whereas 102 patients were treated by LIA in group 2. The demographic data, as well as the American Society of Anesthesiologists Score (ASA Score) were collected. The pain intensity was measured objectively with a numeric rating scale (NRS) in the morning and evening. The pain medication was given according to two protocols with a fix opioid dose for the first 3 days only, additional pain medication could be requested by the patient at any time. Not only the dosage but also the number of additional pain medication was observed. The range of motion was measured from the second postoperative day. Results: This study showed no statistical difference between the two groups regarding sex, operated side and ASA-score. The pain intensity showed statistical difference between the groups, with the LIA group showing a lower pain intensity in the early postoperative phase, especially in the first days and in the morning. On the 1st postoperative day the average of the numeric pain scale for the nerve block group was 2,3 (SD = 1,6), which was significant higher than the average of the LIA group 1,5 (SD = 1,1). The measurements in the evening show that during the first seven postoperative days there was no significant difference for the pain intensity. The average dose of Oxycodon received on the first postoperative day was 17,8 mg (SD = 9,1) in the nerve block group and 11,5 mg (SD = 6,2) in the LIA group, on the 6th day the dosage received was 10,9 mg (SD = 11,3) respectively 6,0 mg (SD = 7,3). On the first postoperative day 50% of the nerve block group received no additional non-opioid medication, 36% received one additional and 14% received two additional non-opioid medication. In the LIA group 67% received no additional medication, 32% received one additional and only 1% received two additional non-opioid medication. And finally the LIA group showed a statistical better range of motion of the operated knee in the early postoperative phase, on the 2nd day 46° +- 10 versus 36° +- 7 with p = 0,000 and on 7th day 79° +- 14 versus 73° +- 12 with p = 0,016. Conclusion: The LIA group showed in this study a significant lower consumption dose of opioid and a quicker recovery of range of motion then the 3 in 1 nerve block group. Furthermore additional pain medication could be reduced during the hospital stay.