Multimodal Analgesia for Accelerated Rehabilitation after Total Knee Arthroplasty: A Randomized, Double-Blind, Controlled Trial on the Effect of the Co-Application of Local Infiltration Analgesia and Femoral Nerve Block Combined with Dexmedetomidine

Abstract

Background: Multimodal postoperative pain regimens are widely used following total knee arthroplasty (TKA). However, there are few studies on the rehabilitation of the co-application of local infiltration analgesia (LIA) and femoral nerve block (FNB) combined with dexmedetomidine (DEX) for patients undergoing TKA. This study aimed to investigate the effect of LIA plus FNB and co-application of perioperative DEX on TKA outcomes. Methods: 95 patients were randomized into two groups. Patients in group B (n = 48) received a single preoperative FNB and LIA. Patients in group A (n = 47) received FNB and LIA, as well as continuous intravenous injection of DEX starting from the induction of anesthesia to postoperative day 2. All patients were allowed patient-controlled analgesia postoperatively. Visual analog scale (VAS) scores, knee range of motion (ROM) degrees, narcotic consumption, length of hospital stay (LOS), complications, Hospital for Special Surgery (HSS) scores and Montreal Cognitive Assessment-Basic (MoCA-B) Scores were recorded. Results: In group A, the mean VAS scores at rest and during movement were lower, the amount of rescue analgesia was decreased, first time of ambulation was reduced, ROM was improved, MoCA-B Scores were increased, LOS was shorter, HSS scores were higher postoperatively compared with group B (all p < 0.05). Conclusion: Our study indicated multimodal analgesia involving a single FNB and LIA combined with DEX accelerates rehabilitation for patients undergoing TKA.

Establishment and evaluation of a predictive model for length of hospital stay after total knee arthroplasty: A single-center retrospective study in China

“…LOS is critical in hospital resource allocation due to the current scenario of cost-conscious in healthcare ( 20 ). Advances in surgical techniques, such as the use of a minimally invasive approach ( 21 ), multiple pain management modalities ( 11 ), and early mobilization after surgery, have aided in reducing LOS in hospitalized patients ( 22 ). Moreover, the upcoming payment model for diagnosis-related groups will further stimulate shorter LOSs.…”

“…As the proportion of hospitalization costs will further increase, reducing the length of stay (LOS), after TKA is essential to ease the economic burden on the patients as well as the healthcare system. The LOS following TKA has decreased substantially in recent years, which is somewhat related to the introduction of enhanced recovery protocols emphasizing multimodal analgesia and rapid mobilization ( 11 , 12 ). Day-case surgeries have become quite challenging in joint arthroplasties.…”

Analgesic efficacy of local infiltration anaesthesia versus femoral nerve block in alleviating postoperative wound pain following total knee arthroplasty: A systematic review and meta‐analysis

“…On the contrary, FNB is characterized by its potent and prolonged pain‐relieving properties, offering a more sustained analgesic effect that extends beyond the immediate postoperative period 15 . This extended duration of action makes FNB a favourable option for maintaining longer‐term postoperative analgesia 16,17 . This is a significant concern, given the emphasis on early mobilization as a cornerstone of postoperative rehabilitation in TKA 1,18 .…”

“… 15 This extended duration of action makes FNB a favourable option for maintaining longer‐term postoperative analgesia. 16 , 17 This is a significant concern, given the emphasis on early mobilization as a cornerstone of postoperative rehabilitation in TKA. 1 , 18 Nonetheless, FNB has shown higher patient satisfaction rates and a reduction in morphine usage, indicating its potential benefits in specific clinical scenarios.…”

Impact of Opioid-Free Anesthesia on Postoperative Quality of Recovery in Patients After Laparoscopic Cholecystectomy-A Randomized Controlled Trial

“…It consists of a variety of non-opioid narcotic drugs and techniques with different mechanisms of action and different targets in the pain transduction pathways to obtain high-quality anesthesia, avoid opioid-related adverse reactions, relieve pain to the maximum extent and promote patient recovery. 4 At present, OFA is increasingly promoted in clinical practice and widely used in gynecology, orthopedics and gastrointestinal laparoscopic surgeries. 5 It can control postoperative pain effectively, decrease the incidence of long-term chronic pain, reduce opioid drug consumption, speed up postoperative recovery, relieve patient anxiety and shorten the length of hospital stay.…”