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To evaluate the effect of the local infiltration of analgesics for pain after total knee arthroplasty in patients treated with femoral and sciatic peripheral nerve blocks.
Local
infiltration analgesia (LIA) is a simple, surgeon-administered technique where
intra-operative administration of local anaesthetic in different combinations
with epinephrine, non-steroidal anti-inflammatory drugs, opioids, steroids or
all to the wound is employed for the treatment of knee (TKA) arthroplasty. This
research shows that the presence of peripheral nerve block leads to the
variations in reducing the pain after TKA.
To evaluate the
effect of the local infiltration of analgesics for pain after total knee
arthroplasty in patients treated with femoral and sciatic peripheral nerve
blocks. The secondary objective was to detect differences in analgesic
consumption as well as blood loss after local infiltration of analgesics.
Prospective
randomized double-blinded study in patients who underwent a TKA for knee
osteoarthritis under spinal anesthesia and treated with femoral and sciatic
nerve blocks. This study compared 50 patients treated with local infiltration
with ropivacaine, epinephrine, ketorolac and clonidine and 50 patients treated
with a placebo with the same technique. The visual analogic score was
registered postoperatively at 2, 6, 12, 24, 36, 48 and 72 h after surgery.
Analgesic consumption was also registered. Both groups of patients were treated
with the same surgical and rehabilitation protocols.
A significant
difference of one point was found in the visual analogic pain scores 12 h after
surgery (0.6 ± 1.5 vs. 1.7 ± 2.3). There were no significant differences in the
visual analogic pain scores evaluated at any other time between 2 and 72 h
after surgery. No significant differences were found in the required doses of
tramadol or morphine in the postoperative period. Postoperative hemoglobin and
blood loss were also similar in both groups.
Adding local
infiltration of analgesics to peripheral nerve blocks after TKA surgery only
provides minimal benefit for pain control. This benefit may be considered as
non-clinically relevant. Moreover, the need for additional analgesics was the
same in both groups. Therefore, the use of local infiltration of analgesics
treatment in TKA surgery cannot be recommended if peripheral nerve blocks are
used.
Knee surgery, sports traumatology, arthroscopy
Local infiltration analgesia adds no clinical benefit in pain control to peripheral nerve blocks after total knee arthroplasty
Pedro Hinarejos et al.
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