Role of epidural analgesia in improving post-operative rehabilitation after primary definitive fixation of periarticular knee fractures followed by orthopaedic trauma

Abstract

Introduction: Role of epidural analgesia is well established in the literature and practice. Epidural anaesthesia is a very common procedure of anaesthesia for induction of lower limb orthopaedic cases. Considering the intra-articular fractures of the knee, they are one of the most common fractures associated with knee stiffness. Even after an adequate and rigid fracture fixation early rehabilitation is necessary to drastically improve the outcome and reduce stiffness. Hence, epidural analgesia through a lumbar epidural catheter is the most commonly used protocol in top up after surgery for post-operative analgesia. The aim of this study is to evaluate whether this method of post-operative analgesia can be helpful in improving rehabilitation after peri-articular knee injuries. Methodology: This is a prospective study. A total of 40 patients with peri-articular of distal femur and proximal tibia were included in the study. Patients were randomised into 2 groups. Group A was given spinal anaesthesia for surgery and Group B was given combined spinal plus epidural anaesthesia with a lumbar epidural catheter. Site chosen was L1-L2 /L2-L3 for epidural analgesia and site for spinal analgesia was L3-L4 was used (in case of combined spinal epidural).Post operatively knee ROM was initiated on day 1 in both the groups. Total knee ROM was recorded on Day 2, Day 10, Day 42 (6 weeks) and Day 90 (3 months). Assessment of knee ROM was done by a single observer who was blinded for the groups. Results: A total of 40 patients were included in this study, out of which 9 were female and 31 were males. Mean knee range of motion for group A was 20 degrees on day 2, 45 degrees at Day 10, 90 degrees at 6 weeks and 120 degrees at 3 months whereas the mean knee range of motion for group B was 40 degrees on day 2, 70 degrees at Day 10, 110 degrees at 6 weeks and 130 degrees at 3 months. Conclusion: Peri-articular knee fractures are a common cause of limitation in knee function despite proper surgery which can be due to inadequate rehabilitation. To address this problem, it is important to give a pain-free post-operative period to the patient to develop and initiate proper post-operative rehabilitation. This can be achieved by performing peri-articular fracture fixations using Epidural anaesthesia through which post-operative analgesia can be continued in a more effective manner which also increases overall outcome of the patient.