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

Abstract

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.

Pain management of unicompartmental (UKA) vs. total knee arthroplasty (TKA) based on a matched pair analysis of 4144 cases

“…Patients were divided into two groups in question: UKA (n = 2117) and TKA (n = 3798). The following statistical evaluation was performed according to Greimel et al 28 , 29 . To get comparable groups in size and distribution of the confounding variables a 1:1 match was performed.…”

Postoperative Pain Management in Total Knee Arthroplasty

“…Among the patients undergoing TKA, those patients who received intraoperative LIA achieved improvement in pain scores and comparable satisfaction levels, with reduced total narcotic consumption in the early postoperative period compared to those with placebo infiltration. FNB is widely considered as an effective postoperative pain management protocol.…”

Fast-Track-Endoprothetik

“…Es werden lokal und oral wirksame Analgetika eingesetzt – unter Berücksichtigung der Nebenwirkungsprofile eingesetzter Pharmazeutika, insbesondere auch der Opioide, die zurückhaltend eingesetzt werden sollten. Der Einsatz einer lokalen Infiltrationsanalgesie (LIA) in Kombination mit oralen Analgetika wird in der Knieendoprothetik favorisiert und ist auch an der Hüfte weit verbreitet [ 3 , 14 , 16 , 34 , 38 , 41 , 47 ]. Es wurden eine Reduktion des postoperativen Schmerzes, eine Verbesserung der Funktion sowie eine Reduktion der Dauer des Krankenhausaufenthaltes beschrieben [ 4 , 14 , 36 , 44 ].…”