Additional benefit of local infiltration of analgesia to femoral nerve block in total knee arthroplasty: double-blind randomized control study

Abstract

Purpose Multimodal analgesia has become an important concept in current pain management following total knee arthroplasty (TKA). However, controversy remains over what is the most accepted combination. In this study, the additional benefits of local infiltration of analgesia to femoral nerve block were evaluated. Methods Forty patients were randomly allocated into a combined local infiltration of analgesia and femoral nerve block or femoral nerve block alone group. In the former, analgesic drugs consisting of ropivacaine and dexamethasone were injected into the peri‐articular tissues, while the same amount of saline was injected into the femoral nerve block group. The primary outcome measure was the total amount of fentanyl consumption by the patient‐controlled analgesia pump during the 48‐h post‐operative period. Results A combination of local infiltration of analgesia and femoral nerve block had less total fentanyl consumption and a larger knee ROM at post‐operative day 2 than femoral nerve block alone (p < 0.05). C‐reactive protein levels in the combined treatment group were significantly lower than the femoral nerve block group at post‐operative day 3 (p < 0.01). There was no difference between the two groups, post‐operatively, on the visual analogue scale for pain at rest or while walking, quadriceps strength, timed up and go test, circumference of thigh, Knee Society Score, and Western Ontario and McMaster Universities Osteoarthritis Index. Conclusion The addition of local infiltration of analgesia to femoral nerve block promoted post‐operative pain relief and the recovery of knee ROM in the early post‐operative period. This combination is an effective method for post‐operative pain management after TKA. Level of evidence Randomized controlled trial, Level I.

Postoperative Pain Management in Total Knee Arthroplasty

“…Postoperatively, multimodal analgesia includes pharmacologic agents, neuraxial anesthesia, PNB, and PCA, each of which will be described below. Compared with a monotherapy, multimodal analgesia provides superior postoperative pain relief to promote recovery of the knee, and reduce opioid consumption and related side effects. Consequently, multimodal analgesia is used widely for perioperative pain control in patients undergoing TKA.…”

“…PCA is safe and effective for treating moderate to severe pain and has become increasingly popular for use in patients undergoing TKA. Currently, opioid drugs are commonly administered by PCA, adding to multimodal analgesia.…”

“…Total knee arthroplasty (TKA) is commonly performed in patients with end‐stage osteoarthritis or rheumatic arthritis of the knee to relieve joint pain, increase mobility, and improve quality of life. However, TKA is followed by moderate to severe postoperative pain. In patients received TKA, 60% experience severe postoperative knee pain and 30% experience moderate pain.…”

Adductor canal block combined with local infiltration analgesia with morphine and betamethasone show superior analgesic effect than local infiltration analgesia alone for total knee arthroplasty: a prospective randomized controlled trial

“…LIA has been regarded as an alternative technique for pain control. LIA with ropivacaine alone may provide effective analgesic effects [ 23 ]. Moreover, ropivacaine combined with steroids may have better analgesic effects than ropivacaine alone.…”

Postoperative analgesia in total knee arthroplasty

“…1,2 TKA is commonly performed in patients with end-stage osteoarthritis or rheumatic knee arthritis to relieve joint pain, increase mobility, and improve quality of life. 3 Despite advances in surgical techniques, management of the postoperative pain in this type of patient is still deficient. 4 The term pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.…”