Potential superiority of periarticular injection in analgesic effect and early mobilization ability over femoral nerve block following total knee arthroplasty

Abstract

Purpose Pain management after total knee arthroplasty (TKA) should permit early knee mobilization with minimal pain. Periarticular injection (PAI) with local anaesthetics has been recently discussed as a protocol of pain control. The purpose of this review of the literature was to evaluate the efficacy of PAI in comparison with femoral nerve block (FNB). Methods A literature search was performed in PubMed, EMBASE, the OVID database and the Cochrane Library databases. Risk of bias was assessed using the Cochrane collaboration tool. Outcomes of interest included narcotic consumption, pain score, early mobilization ability, length of stay and adverse effects or events. Results Research identified 918 articles, of which six with a total of 284 knees, met the inclusion criteria and were eligible for the current study. Conflicting evidence was found in terms of narcotic consumption on the postoperative day 1 and early mobilization ability. Total narcotic consumption, pain score in the first 2 days after surgery, length of stay and adverse effects or events showed no difference between two groups. Lower pain score on the day of surgery was detected after PAI. When compared to continuous FNB, patients in PAI group showed a tendency to achieving better ability of early mobilization. Conclusions In consideration of its relatively simple practice and its potential in analgesic effects or early mobilization ability, PAI had superiority to FNB in the management of pain control after TKA. Before PAI could be widely used in clinical practice after TKAs, further investigations would be necessary to confirm or refute our observed results and to unify the protocol of PAI. Level of evidence I.

Pain Management in Total Knee Arthroplasty: A Comparison of Periarticular Infiltration with Femoral and Sciatic Nerve Block

“…Pain Management in Total Knee Arthroplasty: A Comparison of Periarticular Infiltration with Femoral and Sciatic Nerve Block continuous epidural analgesia, periarticular infiltration of drugs (PAI) during surgery [4], peripheral nerve blocks (femoral nerve or sciatic nerve) [5], continuous intraarticular infusion of anesthetics [6], and postoperative systematic and oral analgesics [7], is now the standard of care in managing pain after TKAs.…”

“…A periarticular injection (PAI) consists of a variable combination of drugs (and their doses) [4], including local anesthetics, nonsteroidal anti-inflammatory drugs, epinephrine and steroids. An extended release preparation of a local anesthetic, the liposomal Bupivacaine [8] with the trade name Exparel ® , has become a recent addition to the list of drugs and their doses used for PAI.…”

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

“…[17][18][19] Accordingly, local infiltration analgesia (LIA) was suggested as a relatively simple method for post-op pain relief. [20][21][22][23][24][25] Potentially, this method should reduce the rate of hemodynamic or neurological side effects and is technically and logistically less complicated and, therefore, more cost-effective. 26,27 The effectiveness of peripheral nerve block compared to other modalities of post-op pain control is the subject of ongoing debate 28 ; however, such information is of high importance for improving post-op pain control and its relation to the functional rehabilitation of patients.…”

Pain Management and Anesthesia in Total Knee Arthroplasty

“…The analgesic efficacy and safety of periarticular injections and femoral nerve block still remain controversial14,15). Lee reviewed recent meta-analyses on this topic with careful consideration into administration methods.…”

“…Their conclusion was that the analgesic effect of the periarticular injection was greater than that of the single-shot femoral nerve block without serious complications. However, controversy still surrounds this issue due to the huge heterogeneity of dosage, analgesics regimens, administration methods, and techniques in previous literatures6,14,15).…”