Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Abstract

Background The postoperative analgesic potential of periarticular anesthetic infiltration (PAI) after TKA is unclear as are the complications of continuous femoral nerve block on quadriceps function. Questions/purposes We asked (1) whether PAI provides equal or improved postoperative pain control in comparison to a femoral nerve block in patients who have undergone TKA; and (2) if so, whether PAI improves early postoperative quadriceps control and facilitates rehabilitation. Methods We randomized 60 patients to receive either PAI or femoral nerve block. During the first 5 days after TKA, we compared narcotic consumption, pain control, quadriceps function, walking distance, knee ROM, capacity to perform a straight leg raise, and active knee extension. Medication-related side effects, complications, operating room time, and hospitalization duration were compared.

The Chitranjan Ranawat Award: Periarticular Injections and Femoral & Sciatic Blocks Provide Similar Pain Relief After TKA: A Randomized Clinical Trial

“…However, patients receiving the PAI also had higher narcotic consumption on the day of surgery, which is unlikely to be the result of the anesthesiologist bias to give narcotics in this group, but rather a result of true increased narcotic demand in this group of patients. The increased narcotic use on the day of surgery found in our study is in distinction to that of other authors [9,34]. Like with the pain scores in their study, Chaumeron et al [9] found lower narcotic consumption in the first 8 hours postoperatively but no difference thereafter.…”

“…Although no other study used the same pain management protocols, similar studies comparing periarticular injection with nerve blocks showed results close to our study. In a recent clinical trial, Chaumeron et al [9] used a single-strength periarticular injection, which was redosed through an intraarticular catheter on postoperative day 1 and compared this with an indwelling femoral nerve catheter (no sciatic block) used for 48 to 72 hours. This study found lower pain scores for the first 8 hours after surgery in the periarticular injection group and no difference thereafter [9].…”

“…In a recent clinical trial, Chaumeron et al [9] used a single-strength periarticular injection, which was redosed through an intraarticular catheter on postoperative day 1 and compared this with an indwelling femoral nerve catheter (no sciatic block) used for 48 to 72 hours. This study found lower pain scores for the first 8 hours after surgery in the periarticular injection group and no difference thereafter [9]. Other similar studies found opposing results: Carli et al [8] found no differences in pain scores and Toftdahl et al [34] and Affas et al [2] found lower scores in patients receiving periarticular injection compared with those receiving isolated femoral nerve blocks during the first postoperative day [2,8,34].…”

“…Two of the more common methods of pain management include peripheral nerve blocks (femoral with or without sciatic nerve block) and intraarticular/periarticular injections. The perceived advantage of peripheral nerve blocks is effective pain management; disadvantages include slower recovery of lower extremity function [9], time required for the procedure, complications related to the block [14,21,29], and added cost. Because of the limited duration of action of the local anesthetic, there is the perception that single periarticular injections may not provide good pain relief beyond the first day [20].…”

“…Because of the limited duration of action of the local anesthetic, there is the perception that single periarticular injections may not provide good pain relief beyond the first day [20]. However, they are simpler to administer, provide for earlier return of lower extremity function [9], may have a lower risk of complications, and are less costly [2]. Many authors have shown that periarticular injections provide improved pain relief compared with no injection [6,22,36].…”