A Multimodal Analgesia Protocol for Total Knee Arthroplasty

Vendittoli, Pascal-André; Makinen, Patrice; Drolet, Pierre; Lavigne, Martin; Fallaha, Michel; Guertin, Marie-Claude; Varin, F.

doi:10.2106/00004623-200602000-00005

Cited by 135 publications

(28 citation statements)

References 30 publications

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“…Local anaesthetic has become a relatively common adjunct for pain relief in arthroplasty. 12,15,19 It was proposed that reduced postoperative pain would allow for a shorter length of stay. This doubleblinded randomized trial has shown no difference in length of stay after utilizing LIA.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] Epidural analgesia has been shown to be more effective than parenteral analgesia alone but can be associated with partial motor blockade, delayed mobilization, urinary retention and epidural haematoma (with anticoagulation therapy). [8][9][10][11] Some studies have suggested pain relief from LIA results in reduction in hospital length of stay; [12][13][14][15][16] however, other studies have shown no conclusive reduction in hospital stay in patients where LIA was utilized. 17,18 Hospital length of stay may be influenced by mul-tiple factors following arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Short‐term outcomes of local infiltration anaesthetic in total knee arthroplasty: a randomized controlled double‐blinded controlled trial

Mulford

Watson

Broe

et al. 2015

ANZ Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Short‐term outcomes of local infiltration anaesthetic in total knee arthroplasty: a randomized controlled double‐blinded controlled trial

Mulford

Watson

Broe

et al. 2015

ANZ Journal of Surgery

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“…Many authors have shown that LIA provide improved pain relief compared with no injection [9–12]. The analgesic effect of LIA varies due to the ingredients of the cocktail, and adding steroid in LIA has the effect of reducing inflammation, decreasing early pain relief, and improving recovery in TKA [13].…”

Section: Introductionmentioning

confidence: 99%

“…The addition of a SNB to a FNB also provides better pain relief than FNB alone [8, 14–16]. A previous study on the efficacy of SNB has shown that 67% of patients who had a preoperative FNB required the addition of a postoperative SNB [9]. …”

Section: Introductionmentioning

confidence: 99%

Local infiltration of analgesia and sciatic nerve block provide similar pain relief after total knee arthroplasty

Tanikawa¹,

Harato

Ogawa

et al. 2017

J Orthop Surg Res

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BackgroundAlthough femoral nerve block provides satisfactory analgesia after total knee arthroplasty (TKA), residual posterior knee pain may decrease patient satisfaction. We conducted a randomized controlled trial to clarify the efficacy of the sciatic nerve block (SNB) and local infiltration of analgesia with steroid (LIA) regarding postoperative analgesia after TKA, when administrated in addition to femoral nerve block (FNB).MethodsSeventy-eight patients were randomly allocated to the two groups: concomitant administration of FNB and SNB or FNB and LIA. The outcome measures included post-operative pain, passive knee motion, C-reactive protein level, time to achieve rehabilitation goals, the Knee Society Score at the time of discharge, patient satisfaction level with anesthesia, length of hospital stay, surgical time, and complications related to local anesthesia.ResultsThe patients in group SNB showed less pain than group LIA only on postoperative hours 0 and 3. Satisfactory postoperative analgesia after TKA was also achieved with LIA combined with FNB, while averting the risks associated with SNB. The influence on progress of rehabilitation and length of hospital stay was similar for both anesthesia techniques.ConclusionsThe LIA offers a potentially safer alternative to SNB as an adjunct to FNB, particularly for patients who have risk factors for sciatic nerve injury.

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“…Phillips et al already reported in 1995 that 11 PWH undergoing a TKA required significantly more opiate analgesia [27], but part of the reason was that nonsteroidal anti-inflammatory drugs were prescribed less in this group. A multimodal analgesia protocol proved that less morphine consumption was seen when using local anaesthetics [28]. Although regional anaesthesia has been considered a contraindication, Sripada et al proved in two cases that it is a safe procedure in haemophilia [29].…”

Section: Discussionmentioning

confidence: 99%

In-hospital rehabilitation after multiple joint procedures of the lower extremities in haemophilia patients: clinical guidelines for physical therapists

Kleijn

Fischer

Vogely³

et al. 2011

Haemophilia

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This project aimed to develop guidelines for use during in-hospital rehabilitation after combinations of multiple joint procedures (MJP) of the lower extremities in persons with haemophilia (PWH). MJP are defined as surgical procedures on the ankles, knees and hips, performed in any combination, staged, or during a single session. MJP that we studied included total knee arthroplasty, total hip arthroplasty and ankle arthrodesis. Literature on rheumatoid arthritis demonstrated promising functional results, fewer hospitalization days and days lost from work. However, the complication rate is higher and rehabilitation needs optimal conditions. Since 1995, at the Van Creveldkliniek, 54 PWH have undergone MJP. During the rehabilitation in our hospital performed by experienced physical therapists, regular guidelines seemed useless. Guidelines will guarantee an optimal physical recovery and maximum benefit from this enormous investment. This will lead to an optimal functional capability and optimal quality of life for this elderly group of PWH. There are no existing guidelines for MJP, in haemophilia, revealed through a review of the literature. Therefore, a working group was formed to develop and implement such guidelines and the procedure is explained. The total group of PWH who underwent MJP is described, subdivided into combinations of joints. For these subgroups, the number of days in hospital, complications and profile at discharge, as well as a guideline on the clinical rehabilitation, are given. It contains a general part and a part for each specific subgroup.

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A Multimodal Analgesia Protocol for Total Knee Arthroplasty

Cited by 135 publications

References 30 publications

Short‐term outcomes of local infiltration anaesthetic in total knee arthroplasty: a randomized controlled double‐blinded controlled trial

Short‐term outcomes of local infiltration anaesthetic in total knee arthroplasty: a randomized controlled double‐blinded controlled trial

Local infiltration of analgesia and sciatic nerve block provide similar pain relief after total knee arthroplasty

In-hospital rehabilitation after multiple joint procedures of the lower extremities in haemophilia patients: clinical guidelines for physical therapists

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