Single periarticular local infiltration analgesia reduces opiate consumption until 48 hours after total knee arthroplasty

Niemeläinen, Mika; Kalliovalkama, Jarkko; Aho, A. J.; Moilanen, Teemu; Eskelinen, Antti

doi:10.3109/17453674.2014.961399

Cited by 68 publications

(42 citation statements)

References 16 publications

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“…A single LIA intraoperative injection seems to be the most effective treatment. 10,[20][21][22][23]33 Delayed infiltration during postoperative care doesn't seem to be more effective. 4,26,27 We decide to compare FNB associating LIA because previous studies had well indicated the effectiveness of these two methods in relieving pain after knee replacement surgery.…”

Section: Discussionmentioning

confidence: 99%

Can local infiltration analgesia increase satisfaction in postoperative short-term pain control in total knee arthroplasty?

Barastegui

Robert

Palau

et al. 2017

J Orthop Surg (Hong Kong)

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Background: One of the major challenges to total knee arthroplasty (TKA) is optimal pain control. Effective analgesia is capital in fast-track surgery programs to allow patient's early functional outcomes. Objectives: Compare length of stay (LOS) short-term pain control, and patients' satisfaction at 1 month between local infiltration analgesia (LIA) combined with femoral nerve block (FNB) and FNB only in patients undergoing TKA. Patients and methods: Two hundred and fifty-four patients were included in a randomized prospective study and distributed in two groups. The first group received an intraoperative LIA (150 mL mixture of ropivacaine 2.0 mg/mL þ ketorolac 30 mg þ adrenaline 10 mg/mL) combined to an FNB. The control group had only an FNB. Demographical data and visual analog scale (VAS) score were obtained preoperatively, at 36 h after surgery and at the 15-day follow-up. Patients' satisfaction at 1 month was also evaluated. Statistical analysis data was performed. Results: No differences in demographical data and preoperative VAS score were observed between both groups. LIA group had a lower VAS score at 36 h after surgery (1.34 + 1.31 vs. 3.68 + 1.932 in the control group, p ¼ 0.00), but these differences were not maintained at the 15-day follow-up (4.51 + 1.889 vs. 4.11 + 1.940 in the control group, p > 0.05). LOS and patients' satisfaction were comparable between groups. Patients with LIA had no additional complications. Conclusions: LIA is a safe adjuvant to FNB to reduce perioperative pain during the first 36 h after TKA. Its effects wean with time, but do cover the first crucial hours of rehabilitation in a fast-track program. LIA seems don't modify postoperative course nor patient's satisfaction at short-term follow-up. The final impact of LIA on surgical outcome is still to be determined.

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Section: Discussionmentioning

confidence: 99%

Can local infiltration analgesia increase satisfaction in postoperative short-term pain control in total knee arthroplasty?

Barastegui

Robert

Palau

et al. 2017

J Orthop Surg (Hong Kong)

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“…On the contrary, LIA is limited in terms of its ability to provide long-lasting pain relief. 16,[31][32][33][34][35][36][37][38] The degree of knee flexion has been used to evaluate functional recovery following TKA. In the current study, active knee flexion ROM was significantly greater in the LIA group versus the PI group on POD1.…”

Section: Discussionmentioning

confidence: 99%

Effect of Local Infiltration Analgesia on Functional Outcomes in Total Knee Arthroplasty: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial

et al. 2020

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Local infiltration analgesia (LIA) is a simple, surgeon-administered technique for the treatment of postoperative pain after total knee arthroplasty (TKA). The aim of the study was to investigate the efficacy of LIA and its effects on functional outcomes in TKA. A total of 135 patients with primary TKA were recruited and randomized either to receive LIA or to receive placebo injection (PI). Pain, active range of motion (ROM), knee function score, functional activities, and hospital length of stay (LOS) were assessed before surgery and from postoperative day (POD) 1 to at discharge. Lower pain scores at rest were recorded on POD1 and POD2 in the LIA group (p = 0.027 and p = 0.020, respectively). Lower pain score on walking was recorded on POD1 in the LIA group (p = 0.002). There was a statistically significant difference in active knee flexion between groups on POD1 (p = 0.038). There was a significant difference in LOS between LIA and PI groups. Shorter stay was seen in LIA group. There were no statistically significant differences between the groups in terms of knee function score and functional outcomes. LIA technique is effective for pain management in the early postoperative period. LIA added benefit for knee function in terms of active knee flexion ROM after TKA. A shorter hospital LOS was observed in LIA group. However, we did not find any differences in groups in terms of functional assessment such as ability to rise from a chair and walking capacity.The level of evidence is randomized controlled trial, level I.

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“…A trial that evaluated periarticular infiltration showed a 24% lower median cumulative consumption of oxycodone compared to controls at 48 hours [9]. Celecoxib reduced visual analog pain scores by 38% at 48 hours and reduced opioid requirements by 40% [10].…”

Section: Discussionmentioning

confidence: 99%

A Simple Method Associated With Reduced Opioid Consumption After Total Knee Arthroplasty

Kuo

Grotkopp

2017

The Journal of Arthroplasty

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Keywords: preimplantation immersion anesthesia local anesthetic opioid pain total knee arthroplasty a b s t r a c t Background: Most patients experience moderate to severe pain after total knee arthroplasty (TKA). We hypothesized that intraoperative treatment of cut bone surfaces with local anesthetic (preimplantation immersion anesthesia, PIA) would lead to decreased postoperative pain and opioid consumption. Methods: Records of 76 patients who underwent unilateral, cemented TKA were retrospectively reviewed. For PIA patients, surgical wounds were immersed in local anesthetic solution immediately prior to component implantation. Both PIA (n ¼ 43) and control (n ¼ 33) groups received multimodal pain management, including intra-articular local anesthetic injections. Endpoints were opioid consumption and mean pain scores for postoperative day (POD) 0, 1, and 2. Demographic, medical, and social factors were included in multivariate analyses. Results: PIA patients reported significantly lower mean pain scores than controls on PODs 0 and 1 (both P < .005). Pain scores on POD 2 were similar. PIA patients used 45%-33% less opioids on PODs 0, 1, and 2 (all P < .005). POD 0 pain scores showed a significant interaction between PIA treatment and preoperative opioid use (P ¼ .013). On POD 1, PIA was the only factor associated with lower mean pain scores (P < .001). No factors were significant for POD 2. PIA was the only factor associated with lower postoperative opioid consumption on PODs 0 and 2 (both P < .005). For POD 1, PIA and increasing age (both P .005) were associated with lower postoperative opioid consumption. Conclusion: PIA was associated with significant reductions in opioid use and mean pain scores after TKA.Published by Elsevier Inc.

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Single periarticular local infiltration analgesia reduces opiate consumption until 48 hours after total knee arthroplasty

Cited by 68 publications

References 16 publications

Can local infiltration analgesia increase satisfaction in postoperative short-term pain control in total knee arthroplasty?

Can local infiltration analgesia increase satisfaction in postoperative short-term pain control in total knee arthroplasty?

Effect of Local Infiltration Analgesia on Functional Outcomes in Total Knee Arthroplasty: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial

A Simple Method Associated With Reduced Opioid Consumption After Total Knee Arthroplasty

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