Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplasty

Abstract

Background and purpose The degree of postoperative pain is usually moderate to severe following knee arthroplasty. We investigated the efficacy of local administration of analgesics into the operating area, both intraoperatively and postoperatively.Methods 40 patients undergoing unicompartmental knee arthroplasty (UKA) were randomized into 2 groups in a double–blind study (ClinicalTrials.gov identifier: NCT00653926). In group A (active), 200 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine (total volume 106 mL) were infiltrated intraoperatively into the soft tissue, while in group P (placebo), no injections were given. 21 hours postoperatively, 150 mg ropivacain, 30 mg ketorolac, and 0.1 mg epinephrine were injected intraarticularly via a catheter in group A, whereas patients in group P were injected with the same volume of saline (22 mL).Results Median hospital stay was shorter in group A than in group P: 1 (1–6) days as opposed to 3 (1–6) days (p < 0.001). Postoperative pain in group A was statistically significantly lower at rest after 6 h and 27 h and on movement after 6, 12, 22, and 27 h. Morphine consumption was statistically significantly lower in group A for the first 48 h, resulting in a lower frequency of nausea, pruritus, and sedation. Postoperatively, there were improved functional scores (Oxford knee score and EQ–5D) in both groups relative to the corresponding preoperative values.Interpretation Local injection of analgesics periarticularly at the end of the operation and intraarticularly at 21 h postoperatively provided excellent pain relief and earlier home discharge following UKA. There was a high degree of patient satisfaction in both groups after 6 months (Clinical Trials.gov: NCT 00653926).

Short-term and long-term outcomes of minimally invasive and open transforaminal lumbar interbody fusions: is there a difference?

“…1,19,23 Similarly, nar cotics usage is a surrogate measure for pain, and adequate control of pain has been associated with better outcomes. 4,6 …”

Reducing the length of hospital stay after total knee arthroplasty: influence of femoral and sciatic nerve block

“…These actions may reduce the use of opioids and their potential side effects. [22][23][24][25][26][27][28][29][30][31] Postoperative analgesia with the use of peripheral nerve blocks is not new. Its benefit has been studied and described for some time, with proven pain control postoperatively, low rate of complications and side effects, and shorter LS.…”

“…[18][19][20]22 The lower risk of contact with bacteria commonly found in hospital environments and the lower chance of prolonged immobilization-related events are examples. Measuring the direct economic impact of this strategy is also an aspect of interest.…”

Multimodal Analgesia for Postoperative Pain Management

“…The technique allows virtually immediate mobilization and earlier discharge from hospital. A recent study by Essving et al (Essving et al, 2009) on unicompartmental knee arthroplasty performed with minimal invasive technique, using the LIA technique found significantly shorter hospital stay, lower morphine consumption and pain intensity compared with placebo.…”