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

Abstract

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.

Local Anesthetics’ Toxicity toward Human Cultured Chondrocytes: A Comparative Study between Lidocaine, Bupivacaine, and Ropivacaine

“…According to the current literature data, all these anesthetics do show a good local analgesic effect. [1][2][3][4][5][6][7] Over and above that, a cell-toxic effect could be also observed in several studies dedicated to cartilage ( Table 1). 13,[15][16][17] At present, there is to our knowledge however no uniform recommendation as to which anesthetic should definitely be used for local joint infiltration.…”

“…Here they are used in the form of a local infiltration anesthesia (LIA) and show comparably good analgesic effects, for example, during the utilization of pain catheters. 3,[5][6][7] Lidocaine, ropivacaine, and bupivacaine contribute to the most often-used LAs. Nevertheless, until this day there is no uniform recommendation as to which local anesthetic for joint injection is best suited.…”

Local infiltration analgesia in primary total knee arthroplasty

“…3,4 There is increasing evidence to support the use of LIA in TKA. [4][5][6][7][8] However, other studies have shown that the efficacy of LIA during TKA is not superior to that of previously available methods. [9][10][11] In addition, the use of LIA is reportedly safe, 1,[12][13][14][15] but has only recently been adopted in medical centres in Hong Kong.…”

Quality of life in total knee replacement (TKR) patients – A review

“…Effective analgesia is a key component of fast-track surgery programs to allow patients early functional outcomes [21,22].…”