Additional periarticular catheter shows no superiority over single-shot local infiltration analgesia alone in unicondylar knee replacement

Abstract

Purpose Local iniltration analgesia (LIA) has attracted growing interest in recent years. To prolong the positive efects of LIA, a continuous intraarticular perfusion has been introduced in total knee arthroplasty with good clinical results. The purpose of the present study was to evaluate if similar results can be obtained with the use of a continuous periarticular perfusion in unicondylar knee arthroplasty (UKA). Methods 50 consecutively selected patients undergoing UKA received either a single-shot LIA (control group; n = 25) or single-shot LIA combined with a continuous postoperative periarticular perfusion for 2 postoperative days (intervention group, n = 25). VAS (visual analogue scale) for pain, pain medication consumption and range of lexion were recorded postoperatively for 6 days. The catheter was removed after 2 days. Results Only minor advantages of using a continuous periarticular catheter could be shown. Patients in the intervention group showed signiicant lower VAS scores on day 1 and required signiicant less pain medication on day 6. Further, there was a signiicant diference in the range of lexion on day 3, on which patients of the intervention group were able to bend the knee joint on average by 12° more than patients of the control group. On the other days, any signiicant diferences between the two groups were not observed. Conclusion In summary, the present study could not identify any superiority of a periarticular catheter over single-shot LIA in UKA. Because of additional costs and the potential risk of infection, the conclusion of this study is to not recommend adding a periarticular catheter to the single-shot LIA in UKA. Level of evidenceII Keywords UKA • Unicondylar knee arthroplasty • LIA • Local iniltration analgesia • Perioperative pain management • Total knee replacement Abbreviations UKA Unicondylar knee arthroplasty LIA Local iniltration analgesia VAS Visual analogue scale ROM Range of motion LMWHs Low-molecular-weight heparins * Malin Meier

Comparison of the Effect of Intra-Articular, Periarticular, and Combined Injection of Analgesic on Pain Following Total Knee Arthroplasty

“…There are a handful of articles disclosing a slight risk of transient peroneal nerve palsy (all of which resolved spontaneously within 48 hours after the surgery) with use of the PA method, with incidences of 0.9% 16 , 1.3% 18 , and 6.6% 19 . However, in accordance with many other studies of PA 9,20-23 and IA+PA 24-27 methods, we did not have any case of peroneal nerve palsy in either the IA+PA or the PA analgesic group. Avoiding injection near the fibular head may eliminate the potential risk of transient peroneal nerve palsy.…”

Efficacy of Liposomal Bupivacaine and Bupivacaine Hydrochloride vs Bupivacaine Hydrochloride Alone as a Periarticular Anesthetic for Patients Undergoing Knee Replacement

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