Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty

Abstract

Background and purposePostoperative pain is often severe after total knee arthroplasty (TKA). We investigated the efficacy of the local infiltration analgesia (LIA) technique, both intraoperatively and postoperatively.Methods48 patients undergoing TKA were randomized into 2 groups in a double-blind study. In group A, 400 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine were infiltrated periarticularly during operation. In group P, no injections were given. 21 h postoperatively, 200 mg ropivacaine, 30 mg ketorolac, and 0.1 mg epinephrine were injected intraarticularly in group A, and the same volume of saline was injected in group P. All patients were followed up for 3 months.ResultsMedian morphine consumption was lower in group A during the first 48 h: 18 (1–74) mg vs. 87 (36–160) mg in group P. Postoperative pain was lower at rest in group A during the first 27 h, and on movement during the first 48 h, except at 21 h. Time to fulfillment of discharge criteria was shorter in group A than in group P: 3 (1–7) vs. 5 (2–8) days. Patient satisfaction was higher in group A than in group P on days 1 and 7. The unbound venous blood concentration of ropivacaine was below systemic toxic blood concentrations.InterpretationThe local infiltration analgesia (LIA) technique provides excellent pain relief and lower morphine consumption following TKA, resulting in shorter time to home readiness and higher patient satisfaction. There were few side effects and systemic LA concentrations were low.

The Chitranjan Ranawat Award: Periarticular Injections and Femoral & Sciatic Blocks Provide Similar Pain Relief After TKA: A Randomized Clinical Trial

“…A notable difference between these two studies was the intraoperative infiltration of the posterior capsule in both the injection and nerve block groups in the study by Carli et al [8]. When comparing studies using intraarticular injection after closure of the capsule with intraoperative periarticular injection, unlike pain scores that were generally more favorable with the periarticular injections, narcotic consumption was usually lower in both intraarticular and periarticular injection studies, although the difference tended to be greater for periarticular injections [5,6,12,19,27,36].…”

“…The use of combined sciatic and femoral nerve blocks over femoral nerve block alone has been shown to have improved pain scores and seems more beneficial for pain management [1,10,17]. When comparing intraoperative periarticular injections with intraarticular injections given after closure of the capsule, better pain scores are generally found in studies using periarticular injections [12,15,30,36]. With the exception of a few studies showing minimal improved pain [24,32], the majority of studies using intraarticular injections showed no improvement in pain scores postoperatively [3,5,15,19,27].…”

“…Advances in postoperative pain management after knee arthroplasty have improved short-term pain relief, earlier return of ROM, and in some cases earlier discharge from the hospital [12,13,25,35]. Over the last decade multimodal pain management techniques have become an increasingly common alternative to opioids alone in the management of perioperative pain after knee arthroplasty.…”

Ropivacaine plasma levels following high-dose local infiltration analgesia for total knee arthroplasty

“…Wound catheters can be used to deliver additional local anaesthetic postoperatively [3] and allow analgesia to be extended beyond 24 h [4][5][6][7][8]. Despite the increasing popularity of such techniques, concerns have been expressed regarding the safety of injecting large volumes of local anaesthetic into knee joints during orthopaedic procedures [9].…”

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

“…From these we identified 12 eligible RCTs. [3][4][5][6][7][8][9][10][11][12][13][14] Inter-observer agreement for trial eligibility was good (kappa = 0.75; SE 0.053). Table I reports the characteristics of the included trials and the local anaesthetic protocols used in the trials.…”