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

Tanikawa, Hidenori; Harato, Kengo; Ogawa, Ryō; Sato, Tomoyuki; Kobayashi, Shū; Nomoto, So; Niki, Yasuo; Okuma, Kazunari

doi:10.1186/s13018-017-0616-x

Cited by 16 publications

(17 citation statements)

References 33 publications

(30 reference statements)

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“…The reason for this is due to the multimodal analgesia including PCA pump and LIA which make patients in an acceptable range of pain, thus resulting in a similar degree of pain relief. As for all kinds of peripheral nerve block, LIA has similar pain relief compared with single femoral nerve block [26,27], continuous femoral nerve block [27,28], and single sciatic nerve block [18,20]. 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.…”

Section: Discussionmentioning

confidence: 99%

“…Previous research has shown that some patients experience significant postoperative pain despite the use of FNB [15,16], due to the fact that the posterior part of the knee is innervated by the sciatic nerve. Since LIA is an alternative, convenient anesthetic technique that is usually performed by orthopedic surgeons [10,17], anesthesia via FNB combined with sciatic nerve block (SNB) and LIA are two major options for supplementing FNB to relieve pain after TKA [18,19]. Recent studies have shown that SNB has similar anesthesia effects and opioid consumption than LIA when combined with FNB [20,21]..…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…On the other hand, there are some studies that did not report any advantage of LIA with respect to pain reduction and/or morphine consumption in TKA. 8,10,12 Mulford et al presented a double-blinded study comparing LIA and application of a placebo in 2015 investigating postoperative pain scores, 9 no significant difference in postoperative pain scores was found. Nonetheless, LIA might result in a significant reduction in especially high-intensity pain levels postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Because of that, many recent studies evaluated local infiltration analgesia (LIA), with varying results. 1,[5][6][7][8][9][10][11][12][13][14] Continuous quality improvement strategies can reveal insufficient pain management. To compare and then improve pain management, the "Quality Improvement in Postoperative Pain Management" (QUIPS) project is an outstanding tool.…”

mentioning

confidence: 99%

Matched-Pair Analysis of Local Infiltration Analgesia in Total Knee Arthroplasty: Patient Satisfaction and Perioperative Pain Management in 846 Cases

et al. 2018

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In the recent past, numerous studies evaluating local infiltration analgesia (LIA) with controversial results have been reported. Efforts have been made to improve patients' outcome regarding operation techniques and material, as well as pain management and anesthetic methods. In this study, postoperative pain management and patient satisfaction were evaluated in patients undergoing total knee replacement surgery with or without intraoperative LIA. Within the context of the “Quality Improvement in Postoperative Pain Management” (QUIPS) project, parameters were collected on the first postoperative day. All patients included in this study underwent primary knee replacement surgery with general anesthesia. Parameters were compared after performing a 1:1 matched-pair analysis within 14 orthopaedic departments. Pain levels and pain management satisfaction were measured using the numerous rating scales, and pain medication use was compared. From 2010 to 2015, 2,789 patients who underwent primary knee arthroplasty with general anesthesia were evaluated within the project, of whom a total of 846 patients could be compared after performing a matched-pair analysis. Pain scores were significantly better in the LIA group (p = 0.019 for activity pain, p = 0.043 for maximum pain, p < 0.001 for minimum pain), but pain management satisfaction was not superior (p = 0.083). Patients with LIA required less opioids in the recovery room (p = 0.048), while nonopioid medication did not differ significantly (p = 0.603). At the ward, 24 hours postoperatively, no significant difference in the use for nonopioids (p = 0.789) could be measured, whereas patients in the LIA group received significantly more opioids (p < 0.001). Although LIA achieved improvement in pain score outcome, and a comparable patient satisfaction level in the immediate postoperative course, the use of LIA in knee arthroplasty, controversially discussed in the current literature, was not able to reduce the need for opioid pain medication in this study.

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“…Some studies reported that LI analgesia is a safe and effective treatment option for early functional recovery and pain control in TKA. [3][4][5] However, the safety and effectiveness of PNBs have also improved with the spread of ultrasound-guided techniques in combination with nerve stimulus techniques. In recent studies, it has remained controversial which analgesic technique is appropriate for TKA.…”

Section: Introductionmentioning

confidence: 99%

Comparison of peripheral nerve block with local infiltration analgesia regarding walking ability after total knee replacement: A retrospective, propensity-score matched-pair cohort study

Fukuda

Imai

Simoda

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: It is unclear whether perioperative analgesic techniques affect the functional outcome of total knee replacement (TKR). We investigated the effects of peripheral nerve block (PNB) and local infiltration (LI) on walking ability after TKR. Methods: The medical records of 7143 patients who underwent TKR using general anesthesia with PNB or LI techniques were reviewed. Factors affecting independence and/or improvement of walking after surgery were investigated using multivariate regression analysis. To adjust for baseline differences and minimize selection bias for the chosen analgesic technique, patients were matched by propensity scores. Results: The multivariate regression analysis showed that PNB was associated with independence and/or improvement of walking. Of the 7143 patients, 2755 (39%) received PNB analgesia and 4388 (61%) LI analgesia. After the propensity score matching, the analgesic types were not associated with walking ability. Independence reflected by the total score of daily living activities was higher in the PNB group than in the LI group. The PNB group started rehabilitation later but performed rehabilitation for longer in the initial period than the LI group. Consumption levels of fentanyl, pentazocine, and antiemetics were lower in the PNB group than in the LI group. The PNB group had fewer hypertensive episodes during surgery than the LI group. There was no significant difference in total hospitalization costs between the two groups. Conclusions: No significant difference in postoperative walking ability was found between PNB and LI groups. However, PNB offered some advantages over LI. Future detailed investigations to improve TKR surgery are needed.

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

Cited by 16 publications

References 33 publications

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

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

Matched-Pair Analysis of Local Infiltration Analgesia in Total Knee Arthroplasty: Patient Satisfaction and Perioperative Pain Management in 846 Cases

Comparison of peripheral nerve block with local infiltration analgesia regarding walking ability after total knee replacement: A retrospective, propensity-score matched-pair cohort study

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