A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty

Abstract

BackgroundThere have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion on analgesic requirements and postoperative pain after TKA.Methods40 consecutive patients undergoing elective, primary TKA were randomized into 2 groups to receive either (1) intraoperative wound infiltration with 150 mL ropivacaine (2 mg/mL), 1 mL ketorolac (30 mg/mL), and 0.5 mL epinephrine (1 mg/mL) (total volume 152 mL) combined with intraarticular infusion (4 mL/h) of 190 mL ropivacaine (2 mg/mL) plus 2 mL ketorolac (30 mg/mL) (group A), or (2) epidural infusion (4 mL/h) of 192 mL ropivacaine (2 mg/mL) combined with 6 intravenous administrations of 0.5 mL ketorolac (30 mg/mL) for 48 h postoperatively (group E). For rescue analgesia, intravenous patient-controlled-analgesia (PCA) morphine was used.Morphine consumption, intensity of knee pain (0–100 mm visual analog scale), and side effects were recorded. Length of stay and corrected length of stay were also recorded (the day-patients fulfilled discharge criteria).ResultsThe median cumulated morphine consumption, pain scores at rest, and pain scores during mobilization were reduced in group A compared to group E. Corrected length of stay was reduced by 25% in group A compared to group E.InterpretationPeri- and intraarticular analgesia with multimodal drugs provided superior pain relief and reduced morphine consumption compared with continuous epidural infusion with ropivacaine combined with intravenous ketorolac after TKA.

Intraarticular Analgesia Versus Epidural Plus Femoral Nerve Block After TKA: A Randomized, Double-blind Trial

“…Nonetheless, an intraarticular continuous infusion of ropivacaine, in particular, has been shown to be efficacious in reducing postoperative pain and opioid requirements when compared to placebo in prior studies [8,15]. However, the superiority of a continuous intraarticular infusion of ropivacaine over other commonly used analgesic methods, such as epidural analgesia or FNB, has yet to be definitely determined [1,18]. Furthermore, no prior study has compared a continuous intraarticular infusion of ropivacaine to a combined regimen of epidural analgesia and FNB.…”

Periarticular local anaesthetic in knee arthroplasty: A systematic review and meta-analysis of randomised trials

“…As far as we are aware there are no large, high quality studies into the cost effectiveness of Lai; however, the simplicity of the procedure and decreased systemic analgesic requirements demonstrated by some studies imply it may be a cost-effective method of providing analgesia. 3,12 There was significant variation in the technique of performing LAi between the studies included in our metaanalysis, which may have contributed to the heterogeneity.…”

“…From these we identified 12 eligible RCTs. [3][4][5][6][7][8][9][10][11][12][13][14] Inter-observer agreement for trial eligibility was good (kappa = 0.75; SE 0.053). Table I reports the characteristics of the included trials and the local anaesthetic protocols used in the trials.…”

“…Ilfeld's review of three RCTs in 2010 suggests a causal link between continuous femoral nerve block and patient falls following total knee arthroplasty 20 and Andersen reported a statistically significant increase in urinary retention and constipation in the epidural group compared to LAi. 3 Vendittoli in 2006 analysed the plasma concentrations of local anaesthetic following LAi and reported that all plasma concentrations were below the toxic range. 12 Neither Andersen nor Venditolli reported any complications directly related to LAi, suggesting it is a safe method of providing analgesia.…”

Hvordan kan sykepleieren fremme pasientmedvirkning i postoperativ smertebehandling?

“…smertebehandling og mobilisering Sykepleierne erfarte at bruk av LIA-kateter bidro til at de fleste pasienter var oppe av sengen operasjonsdagen. Tidligere studier viser at LIA-kateteret har effekt på tidlig mobilisering etter hofteog kneprotesekirurgi (34,35). Et av prinsippene ved Joint Care er å begrense bruk av smerte-og urinkatetre, og ved overgangen til perorale administrasjonsformer erfarte sykepleierne at pasientene ofte rapporterte sterke smerter.…”