Doubtful effect of continuous intraarticular analgesia after total knee arthroplasty

Abstract

Background and purposeLocal infiltration analgesia (LIA) is well established for effective postoperative pain relief in total knee arthroplasty (TKA). To prolong the effect of LIA, infusion pumps with local intraarticular analgesia can be used. We evaluated the effect of such an infusion pump for the first 48 h postoperatively regarding pain, knee function, length of stay (LOS) in hospital, and complications.Patients and methods200 patients received peroperative LIA and a continuous intraarticular elastomeric infusion pump set at 2 mL/h. The patients were randomized either to ropivacaine (7.5 mg/mL) or to NaCl (9 mg/mL) in the pump. Visual analog scale (VAS) pain (0–100 mm), analgesic consumption, side effects of medicine, range of motion (ROM), leg-raising ability, LOS, and complications during the first 3 months were recorded.Results On the first postoperative day, the ropivacaine group had lower VAS pain (33 vs. 40 at 12 noon and 36 vs. 43 at 8 p.m.; p = 0.02 and 0.03, respectively), but after that all recorded variables were similar between the groups. During the first 3 months, the ropivacaine group had a greater number of superficial and deep surgical wound infections (11 patients vs. 2 patients, p = 0.02). There were no other statistically significant differences between the groups.Interpretation Continuous intraarticular analgesia (CIAA) with ropivacaine after TKA has no relevant clinical effect on VAS pain and does not affect LOS, analgesic consumption, ROM, or leg-raising ability. There may, however, be a higher risk of wound-healing complications including deep infections.

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

“…The most effective technique consisted of infiltrating a mixture of high-dose ropivacaine with adrenaline and ketorolac. 10 Single intra-articular versus continuous perfusion were also studied, 19 but no differences were observed between these two techniques. A single LIA intraoperative injection seems to be the most effective treatment.…”

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“…However, there are some major complications for this method, which are wound infection and local anesthetic toxicity. In the study of Ali et al, continuous LIA appeared to have no significant effect on postoperative pain and a higher rate of wound-healing complications and deep wound infections occurred [20].…”

“…It has to be noted that studies discussed here used higher doses of local anesthetic and it has been combined with other analgesic drugs. Furthermore, the continuous method was widely used for administration of LIA [11,14,20,21]. Ropivacaine is a long-acting local anesthetic and has less cardiac toxicity than bupivacaine, but when using high doses it suppresses the central nervous and cardiovascular system.…”

Local anesthetic infusion pump for pain management following total knee arthroplasty: a meta-analysis

“…After reading the titles and abstracts, 49 studies were excluded according to the inclusion criteria. Finally, 7 RCTs [10–18] with 587 TKAs were identified in our study (Fig. 1).…”

“…Williams et al [11] conducted a RCT and found that pain score and morphine consumption are not significantly reduced when adding 48 h of 0.5% bupivacaine infiltration with pain pump. Ali et al [18] also performed a RCT about CLIA with placebo for pain control after TKA and found that CLIA has no relevant clinical effect on VAS pain and does not affect LOS, morphine consumption but with a higher risk of wound-healing complications: deep infections. In this meta-analysis, the pain score was reduced 11.09 score with rest at 24 h and 13.94 score at 24 h with mobilization.…”