ABSTRACT
BACKGROUND: Postoperative pain after total knee arthroplasty (TKA) can be difficult to manage and may delay recovery. Recent studies have suggested that periarticular infiltration with local anesthetics may improve outcome. METHODS: 80 patients undergoing TKA under spinal anesthesia were randomized to receive continuous femoral nerve block (group F) or peri- and intraarticular infiltration and injection (group I). Group I received a solution of 300 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine by infiltration of the knee at the end of surgery, and 2 postoperative injections of these substances through an intraarticular catheter. RESULTS: More patients in group I than in group F could walk < 3 m on the first postoperative day (29/39 vs. 7/37, p < 0.001). Group I also had significantly lower pain scores during activity and lower consumption of opioids on the first postoperative day. No differences between groups were seen regarding side effects or length of stay. INTERPRETATION: Peri- and intraarticular application of analgesics by infiltration and bolus injections can improve early analgesia and mobilization for patients undergoing TKA. Further studies of optimal drugs, dosage, and duration of this treatment are warranted.
Subject(s)
Amides/administration & dosage , Anesthetics, Local/administration & dosage , Arthroplasty, Replacement, Knee/adverse effects , Nerve Block/methods , Pain, Postoperative/therapy , Aged , Analgesia/methods , Analgesics, Non-Narcotic/administration & dosage , Analgesics, Opioid/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Epinephrine/administration & dosage , Female , Femoral Nerve , Humans , Injections, Intra-Articular , Ketorolac/administration & dosage , Length of Stay , Male , Middle Aged , Pain Measurement , Pain, Postoperative/drug therapy , Recovery of Function , Ropivacaine , Treatment OutcomeABSTRACT
Total knee arthroplasty (TKA) is associated with considerable postoperative pain which may be difficult to manage. This article describes advantages and disadvantages of the different analgesic techniques used for pain treatment after TKA, for example i.v. patient-controlled analgesia, epidural pain treatment, and peripheral nerve blocks (especially femoral and sciatic blocks). Randomised studies suggest that peripheral nerve blocks have the best effect and have fewest side effects. Intra-articular administration of analgesics is the most recently introduced technique.