Can local infiltration analgesia increase satisfaction in postoperative short-term pain control in total knee arthroplasty?. (16th February 2017)

• Record Type: Journal Article
• Authors: Barastegui, David; Robert, I; Palau, E; Haddad, S; Reverte-Vinaixa, M; Lorente, L; Cots, M
• Is Part Of: Journal of orthopaedic surgery. Volume 25:Number 1(2017)
• Publication Date: 2017-02-16
• Subjects: analgesia -- fast-track surgery -- local infiltration analgesia; Orthopedic surgery -- Periodicals; Orthopedics; Orthopedic surgery; Periodicals; 617.3
• DOI: 10.1177/2309499017690461
• Languages: English
• ISSNs: 1022-5536

Abstract

Background: One of the major challenges to total knee arthroplasty (TKA) is optimal pain control. Effective analgesia is capital in fast-track surgery programs to allow patient's early functional outcomes. Objectives: Compare length of stay (LOS) short-term pain control, and patients' satisfaction at 1 month between local infiltration analgesia (LIA) combined with femoral nerve block (FNB) and FNB only in patients undergoing TKA. Patients and methods: Two hundred and fifty-four patients were included in a randomized prospective study and distributed in two groups. The first group received an intraoperative LIA (150 mL mixture of ropivacaine 2.0 mg/mL + ketorolac 30 mg + adrenaline 10 μg/mL) combined to an FNB. The control group had only an FNB. Demographical data and visual analog scale (VAS) score were obtained preoperatively, at 36 h after surgery and at the 15-day follow-up. Patients' satisfaction at 1 month was also evaluated. Statistical analysis data was performed. Results: No differences in demographical data and preoperative VAS score were observed between both groups. LIA group had a lower VAS score at 36 h after surgery (1.34 ± 1.31 vs. 3.68 ± 1.932 in the control group, p = 0.00), but these differences were not maintained at the 15-day follow-up (4.51 ± 1.889 vs. 4.11 ± 1.940 in the control group, p > 0.05). LOS and patients' satisfaction were comparable between groups. Patients with LIA had no additional complications. Conclusions: LIA is a safe adjuvant to FNB to reduce perioperative pain during the first 36 h after TKA. Its effects wean with time, but do cover the first crucial hours of rehabilitation in a fast-track program. LIA seems don't modify postoperative course nor patient's satisfaction at short-term follow-up. The final impact of LIA on surgical outcome is still to be determined.