Background: Total knee arthroplasty (TKA) is usually associated with moderate to severe postoperative pain. Peripheral nerve block (PNB) and local infiltration analgesia (LIA) are two major methods for postoperative analgesia. Femoral nerve block (FNB) leads to residual posterior knee pain; thus, currently sciatic nerve block (SNB) and LIA are two major options for supplementing FNB. However, the efficacy and safety of LIA compared with combined femoral and sciatic nerve block still remain controversial. Here, we conducted a study to analyze the postoperative analgesic efficacy of these two methods. Method: Two hundred six patients undergoing TKA were enrolled in a retrospective cohort study. The patients received either PNB or LIA. All patients in PNB group were conducted combined femoral and sciatic nerve block. All patients were encouraged to use patient-controlled analgesia (PCA) after surgery. The postoperative visual analog scale (VAS) at rest or with movement during the first 24 h and 48 h was recorded. We analyzed the VAS of 24 h, VAS of 48 h, opioid consumption, and adverse effects between PNB group and LIA group. Chi-square test and nonparametric test were used in this study. Results: There were 82 patients in the PNB group and 124 patients in the LIA group. The patients' characteristics such as age, height, weight, and ASA showed no significant difference (P > 0.05). No significant differences were found (P > 0.05) between the two groups regarding VAS score at rest or with movement. The LIA group had less opioid consumption than the PNB group but without significant difference (P > 0.05). In both groups, the most common side effect was nausea, and the side effects showed no significant differences between groups (P > 0.05). Conclusion: Local infiltration analgesia provided a similar analgesic effect and complications compared with combined femoral and sciatic nerve block in the short term. Considering less opioid consumption with local infiltration analgesia though without significant difference and its convenience, local infiltration analgesia provided better postoperative analgesia.
To compare pain management outcomes in postoperative patients from an American hospital and a Chinese hospital. A convenience sample of 244 patients in the United States and 268 patients in China with similar surgical sites completed the American Pain Society Patient Outcome Questionnaire-Revised (APS-POQ-R) and the Pain Management Index (PMI) was calculated on their first postoperative day. Patients in the United States reported a higher score on the “perception of pain management” subscale of the APS-POQ-R and a higher proportion of adequate treatment as measured by the PMI (85.2% vs. 39.0%, p < .001). Patient education and degrees of pain relief predicted patient satisfaction with pain management (item in APS-POQ-R) in patients from both countries. A higher level of compliance with pain management guidelines has contributed to a higher level of perception in patients in the United States. Establishing procedure-specific protocols and clinical pathways may improve pain management outcomes for Chinese patients.
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