Analgesic efficacy of local anaesthetic wound administration in knee arthroplasty: volume vs concentration

Andersen, Lea Laird; Gaarn-Larsen, L.; Kristensen, B.; Husted, Henrik; Otte, Kristian Stahl; Kehlet, Henrik

doi:10.1111/j.1365-2044.2010.06452.x

Cited by 26 publications

(26 citation statements)

References 29 publications

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“…10,[20][21][22][23]33 Delayed infiltration during postoperative care doesn't seem to be more effective. 4,26,27 We decide to compare FNB associating LIA because previous studies had well indicated the effectiveness of these two methods in relieving pain after knee replacement surgery. 18,20,22,35,37 Andersen and Kehlet 13,1428 and Xu et al 29 published recent reviews and studies about the effects of LIA in TKA.…”

Section: Discussionmentioning

confidence: 99%

Can local infiltration analgesia increase satisfaction in postoperative short-term pain control in total knee arthroplasty?

Barastegui

Robert

Palau

et al. 2017

J Orthop Surg (Hong Kong)

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Background: One of the major challenges to total knee arthroplasty (TKA) is optimal pain control. Effective analgesia is capital in fast-track surgery programs to allow patient's early functional outcomes. Objectives: Compare length of stay (LOS) short-term pain control, and patients' satisfaction at 1 month between local infiltration analgesia (LIA) combined with femoral nerve block (FNB) and FNB only in patients undergoing TKA. Patients and methods: Two hundred and fifty-four patients were included in a randomized prospective study and distributed in two groups. The first group received an intraoperative LIA (150 mL mixture of ropivacaine 2.0 mg/mL þ ketorolac 30 mg þ adrenaline 10 mg/mL) combined to an FNB. The control group had only an FNB. Demographical data and visual analog scale (VAS) score were obtained preoperatively, at 36 h after surgery and at the 15-day follow-up. Patients' satisfaction at 1 month was also evaluated. Statistical analysis data was performed. Results: No differences in demographical data and preoperative VAS score were observed between both groups. LIA group had a lower VAS score at 36 h after surgery (1.34 + 1.31 vs. 3.68 + 1.932 in the control group, p ¼ 0.00), but these differences were not maintained at the 15-day follow-up (4.51 + 1.889 vs. 4.11 + 1.940 in the control group, p > 0.05). LOS and patients' satisfaction were comparable between groups. Patients with LIA had no additional complications. Conclusions: LIA is a safe adjuvant to FNB to reduce perioperative pain during the first 36 h after TKA. Its effects wean with time, but do cover the first crucial hours of rehabilitation in a fast-track program. LIA seems don't modify postoperative course nor patient's satisfaction at short-term follow-up. The final impact of LIA on surgical outcome is still to be determined.

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Section: Discussionmentioning

confidence: 99%

Can local infiltration analgesia increase satisfaction in postoperative short-term pain control in total knee arthroplasty?

Barastegui

Robert

Palau

et al. 2017

J Orthop Surg (Hong Kong)

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“…[27][28][29] The benefits of the LIA technique are good post-operative pain control, fast mobilisation and early discharge from hospital. [27][28][29][30][31][32] It reduces opioid consumption post-operatively after total knee replacement. [2,5,17,18] It also decreases blood loss.…”

Section: Resultsmentioning

confidence: 99%

Prospective Study of Efficacy of Local Infiltration Analgesia and Epidural Analgesia in Patients Undergoing Total Knee Replacements

Y¹,

Varkey²,

Prakash³

2017

jemds

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BACKGROUNDAims-Multiple studies have been done regarding post-operative analgesia after knee surgeries including intravenous opioids, epidural analgesia and nerve blocks. Hence, we compared the efficacy of Local Infiltration Analgesia (LIA) technique over Epidural Analgesia (EA) technique in patients undergoing TKR surgeries. MATERIALS AND METHODS72 patients of either sex, aged > 50 years, belonging to ASA I to III, posted for unilateral TKR for varus deformity were randomised into two groups. Patients in Group 1 received LIA and Group 2 EA. Parameters assessed were: Pain on VAS scale, Range of Movements (ROM), ambulation with support, patient satisfaction at 6 hrs., 24 hrs., 48 hrs., 72 hrs. and 96 hrs. Post-operatively. RESULTSStatistical analysis of the univariate and multivariate factors was performed using paired 't', Chi-square test, Fisher's test as applicable. The pain was significantly more in LIA group than in EA group at 6 hrs., 24 hrs., 48 hrs., 72 hrs. and 96 hrs. intervals. The ROM was significantly observed more in LIA group than in EA group at 48 hrs. and 72 hrs. However, there was no significant difference at 96 hrs. between both groups. Ambulation with support was possible only in LIA group. Rescue analgesia was needed only in LIA group (13.9% vs 0%). Patients of EA group were more satisfied at the end of 4 days (86.1% vs 69.4%). CONCLUSIONLocal infiltration analgesia provides simple, safe comparable analgesic efficacy and earlier ambulation than epidural analgesia post-operatively after total knee replacement surgery.

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“…Several studies have been performed by Andersen into the optimum technique for LAi, including the location of the injection, the concentration and volume of injectate and the use of bandages to improve spread [21][22][23][24][25] and Williams et al demonstrated no significant benefit from a 48-hour infusion of local anaesthetic following intra-operative infiltration. 13 However, there is still little consensus as to the optimum technique.…”

Section: This Study In Relation To Other Studies and Future Researchmentioning

confidence: 99%

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

Gibbins¹,

Kane²,

Smit³

et al. 2016

SA orthop. j.

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IntroductionThe provision of adequate post-operative analgesia in patients undergoing knee arthroplasty presents a significant challenge. A multimodal approach to pain control in these patients has been commonly adopted with regimens including opioids, nonsteroidal anti-inflammatory drugs, adjuncts such as gabapentin or pregabalin, and the use of neuraxial and peripheral nerve blockade. Peri-articular injections and infusion of local anaesthetic holds great attraction as it provides localised analgesia without the side effects often seen with neuraxial or peripheral nerve blockade. This systematic review and meta-analysis aimed to determine whether, in adults undergoing knee arthroplasty, adding peri-articular local anaesthetic to a post-operative pain regimen improved post-operative pain scores. AbstractBackground: This systematic review and meta-analysis aimed to quantify the effect of adding peri-articular local anaesthetic infiltration or infusion to an analgesic strategy in patients undergoing knee arthroplasty.

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Analgesic efficacy of local anaesthetic wound administration in knee arthroplasty: volume vs concentration

Cited by 26 publications

References 29 publications

Can local infiltration analgesia increase satisfaction in postoperative short-term pain control in total knee arthroplasty?

Can local infiltration analgesia increase satisfaction in postoperative short-term pain control in total knee arthroplasty?

Prospective Study of Efficacy of Local Infiltration Analgesia and Epidural Analgesia in Patients Undergoing Total Knee Replacements

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

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