Postoperative Pain Control by Local Infiltration Analgesia and Peripheral Nerve Block in Primary Prosthetic Total Knee Arthroplasty

Abstract

Background and Objective: Postoperative (post-op) pain control has an important impact on post-op rehabilitation. The logistics of its maintenance challenge the effect of peripheral nerve block on post-op pain control, with the risk for post-op complications. We hypothesized that perioperative use of local infiltration analgesia (LIA) is comparable to post-op pain control by peripheral nerve block. Materials and Methods: We evaluated three groups of patients treated with primary total knee arthroplasty (TKA) due to symptomatic end-stage osteoarthritis with post-op pain control by LIA (LIA group, n=52), femoral plus sciatic nerve block (FSNB) (FSNB group, n=54), and without local or regional analgesia as controls (Control group, n=53). The primary outcome variable was the post-op pain level intensity as measured by the visual analog scale (VAS). Secondary outcome variables were knee function measured by the Knee Society Score (KSS) and the quadriceps muscle strength recovery profile. Results: Up to 4 hours post-op, pain intensity was significantly lower in FSNB patients (P<0.05). This effect of the peripheral nerve block on the pain level disappeared 6 hours post-op. The LIA and FSNB patients showed a significant decrease in pain intensity on days 2 and 3 post-op (P<0.05) with no mutual differences (P>0.05). This effect disappeared on day 4 post-op (P>0.05). The KSS score showed similar significant improvement of functional abilities (P<0.001) in all three groups. There was no difference in KSS scores among the groups 6 months after surgery (P>0.05). Quadriceps muscle recovery profile was similar in the LIA and Control groups, but significantly poorer in the FSNB group (P<0.001). Conclusion: The value of very short-term and improved pain relief of post-op FSNB over LIA of the surgical wound should be carefully weighed against its cost, logistics, and potential complication threat.

Local Periarticular Infiltration with Dexmedetomidine Results in Superior Patient Well-Being after Total Knee Arthroplasty Compared with Peripheral Nerve Blocks: A Randomized Controlled Clinical Trial with a Follow-Up of Two Years

“…Aso et al [61] described that performing LIA in addition to an FNB is an effective method for postoperative pain management after TKA. Lychagin et al [24] compared LIA with combined FNB and SNB in TKA patients and found that the PNB only provided significantly better pain relief 4 h postoperatively, with no further significant differences in pain until the fifth day after surgery. The non-significant difference between both groups differed from our results, which showed significantly more pain on the fifth day after surgery in the LIA group.…”

“…This is one of the reasons that LIA has been the subject of increasing interest in recent years [23]. Besides its advantages regarding lower complication rates and reduced systemic toxicity, the application of LIA in TKA is simple and fast [15,18,24]. Moreover, the analgesic effect of both approaches is reported to be comparable, with no significant difference in the short-term, making LIA a feasible alternative to combined femoral and sciatic nerve blocks [25].…”