Effect of local infiltration analgesia, peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in unicompartmental knee arthroplasty

Abstract

BackgroundThe aim of the study was to analyze the effect of local infiltration analgesia (LIA), peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in primary unicompartmental knee arthroplasty (UKA).MethodsBetween January 2016 until August 2016, 134 patients underwent primary UKA and were subdivided into four groups according to their concomitant pain and anesthetic procedure with catheter-based techniques of femoral and sciatic nerve block (group GA&FNB, n = 38) or epidural catheter (group SP&EPI, n = 20) in combination with general anesthesia or spinal anesthesia, respectively, and LIA combined with general anesthesia (group GA&LIA, n = 46) or spinal anesthesia (group SP&LIA, n = 30). Outcome parameters focused on the evaluation of pain (NRS scores), mobilization, muscle strength and range of motion up to 7 days postoperatively. The cumulative consumption of (rescue) pain medication was analyzed.ResultsThe LIA groups revealed significantly lower (about 50%) mean NRS scores (at rest) compared to the catheter-based groups at the day of surgery. In the early postoperative period, the dose of hydromorphone as rescue pain medication was significantly lower (up to 68%) in patients with SP&EPI compared to all other groups. No significant differences could be detected with regard to grade of mobilization, muscle strength and range of motion. However, there seemed to be a trend towards improved mobilization and muscle strength with general anesthesia and LIA, whereof general anesthesia generally tended to ameliorate mobilization.ConclusionsExcept for a significant lower NRS score at rest in the LIA groups at day of surgery, pain relief was comparable in all groups without clinically relevant differences, while the use of opioids was significantly lower in patients with SP&EPI. A clear clinically relevant benefit for LIA in UKA cannot be stated. However, LIA offers a safe and effective treatment option comparable to the well-established conventional procedures.

Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty

“…However, currently, few studies focus on the comparison between local infiltration analgesia with combined femoral and sciatic nerve block and do not reach a consensus. One of them has the same results as pain relief was similar between the two groups [29,30]; other studies indicate that FNB combined with SNB provides superior pain relief than LIA [31,32]. Therefore, this study enriches existing literatures in this field of comparing combined femoral and sciatic nerve block.…”

Anesthesia and perioperative medicine in orthopedic surgery

“…U inervaciji kolena učestvuju n. tibialis, n. peroneus communis, zadnja grana n. obturatoriusa i n. femoralis. Izbor opšte anestezije sa endotrahealnom intubacijom nosi veliki rizik za nehirurške komplikacije u odnosu na centralnu sprovodnu anesteziju (spinal ili epidural) ili blok perifernih nerava [46][47][48] . Ipak, blokada n. ishiadicusa kod ugradnje totalne proteze kolena sa valgus deformitetom nosi rizik od ranog neprepoznavanja paralize n. ishiadicusa ili n. peroneusa.…”

“…Regionalna anestezija ima prednost i kada je u pitanju kupiranje postoperativnog bola, te se tako preporučuje blokada n. saphenusa, koja omogućava ranu mobilizaciju pacijenata. U cilju postoperativne kontrole bola, kao i rane mobilizacije, danas se primenjuje multimodalni princip analgezije, u okviru koga je sve češća primena periartikularne lokalne infiltracije [46][47][48][49] . Periartikularnom infiltracijom se ubrizgava 120 ml rastvora koji sadrži lokalni anestetik (0,5% bupivakaina ili levobupivakaina 3 mg/kg), opioid (morfin 5 mg), NSAIL (ketorolak 30 mg) i adrenalin (100-300 mcg) u tri faze tokom implantacije proteze kolena.…”

“…Spinalna hirurgija beleži značajan porast poslednjih godina, pri čemu uključuje širok dijapazon operacija, od mikrodisektomije kod uklještenog diska do rekonstruktivne hirurgije deformiteta kičme, uključujući multiple nivoe rada, prednji, zadnji, lateralni pristup ili kombinaciju i značajan gubitak krvi 1, [54][55][56][57] . Većina operacija ove hirurgije se izvodi u opštoj anesteziji.…”

Anestesia intra-articular com ropivacaína para diagnóstico de claudicação em cães

“…A dor pós-operatória imediata de cirurgia artroscópica do joelho também pode ser bem controlada com o uso intra-articular de anestésicos locais (Berninger et al, 2018). Apesar da dor pós artroscopia ter sido relatada como moderada e de curta duração, vários estudos evidenciaram sua redução após uso intra-articular de anestésicos locais, sem efeitos adversos (Salomadas et al, 2006), inclusive quando comparada a técnicas analgésicas tradicionais, como bloqueio de nervos periféricos e epidural (Berninger et al, 2018). Para além do benefício pós-opertaório imediato, Eker et al (2017) demonstraram a analgesia da lidocaína intraarticular por até três meses em pacientes com osteoartrite.…”