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Effects of local infiltration analgesia for posterior knee pain after total knee arthroplasty: comparison with sciatic nerve block

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Abstract

Background

Although femoral nerve block provides good analgesia after total knee arthroplasty (TKA), residual posterior knee pain may decrease patient satisfaction. We compared the efficacy of periarticular infiltration analgesia (PIA) and sciatic nerve block (SNB) for posterior knee pain.

Methods

Forty-nine patients scheduled for TKA were prospectively randomized into the PIA group (n = 25) or SNB group (n = 24) and received general anesthesia with ultrasound-guided femoral nerve block (FNB). In the PIA group, 60 ml 0.5 % ropivacaine and 0.3 mg epinephrine were injected intraoperatively into the periarticular soft tissue before inserting the components. In the SNB group, patients received ultrasound-guided SNB with 20 ml 0.375 % ropivacaine and periarticular infiltration with 20 ml normal saline and 0.3 mg epinephrine. We evaluated postoperative pain scores, posterior knee pain, frequency of rescue analgesics for 36 h, and performance time of PIA and SNB.

Results

Visual analogue pain scores at 12–24 h were significantly lower in the PIA group than in the SNB group (p < 0.05). The majority of patients had no posterior knee pain. There were no significant differences between the groups in frequency and time of first administration of rescue analgesics and in side effects. Time for performance of periarticular infiltration was significantly shorter than that for SNB (p < 0.05). The dose of intraoperative remifentanil was significantly lower in the SNB group than in the PIA group (p < 0.001).

Conclusions

The combination of FNB and PIA provides sufficient analgesia after TKA. The rapid and convenient periarticular infiltration technique could be a good alternative to SNB.

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References

  1. Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A, Murthy Y. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology. 2010;113:1144–62.

    Article  PubMed  Google Scholar 

  2. Zaric D, Boysen K, Christiansen C, Christiansen J, Stephensen S, Christensen B. A comparison of epidural analgesia with combined continuous femoral-sciatic nerve blocks after total knee replacement. Anesth Analg. 2006;102(4):1240–6.

    Article  PubMed  Google Scholar 

  3. Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. 1998;87:88–92.

    PubMed  CAS  Google Scholar 

  4. Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d’Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91:8–15.

    Article  PubMed  CAS  Google Scholar 

  5. Raj PP, Knarr DC, Vigdorth E, Denson DD, Pither CE, Hartrick CT, Hopson CN, Edström HH. Comparison of continuous epidural infusion of a local anesthetic and administration of systemic narcotics in the management of pain after total knee replacement. Anesth Analg. 1987;66:401–6.

    Article  PubMed  CAS  Google Scholar 

  6. Pham Dang C, Gautheron E, Guilley J, Fernandez M, Waast D, Volteau C, Nguyen JM, Pinaud M. The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement. Reg Anesth Pain Med 2005;30:128–133

    Google Scholar 

  7. Morin AM, Kratz CD, Eberhart LH, Dinges G, Heider E, Schwarz N, Eisenhardt G, Geldner G, Wulf H. Postoperative analgesia and functional recovery after total-knee replacement: comparison of a continuous posterior lumbar plexus (psoas compartment) block, a continuous femoral nerve block, and the combination of a continuous femoral and sciatic nerve block. Reg Anesth Pain Med. 2005;30:434–45.

    PubMed  Google Scholar 

  8. Andersen LO, Husted H, Otte KS, Kristensen BB, Kehlet H. High-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand. 2008;52:1331–5.

    Article  PubMed  CAS  Google Scholar 

  9. Andersen KV, Bak M, Christensen BV, Harazuk J, Pedersen NA, Søballe K. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty. Acta Orthop 2010;81(5):606–610

    Google Scholar 

  10. Affas F, Nygårds EB, Stiller CO, Wretenberg P, Olofsson C. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop. 2011;82(3):441–7.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Essving P, Axelsson K, Åberg E, Spenner H, Gupta A, Lundin A. Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial. Anesth Analg 2011;113(4):926–933

    Google Scholar 

  12. Reid JB 3rd, Guttmann D, Ayala M, Lubowitz JH. Minimally invasive surgery-total knee arthroplasty. Arthroscopy. 2004;20(8):884–9.

    Article  PubMed  Google Scholar 

  13. Mahoney FI, Barthel DW. The Barthel index. Md State Med J. 1965;14:61–5.

    PubMed  CAS  Google Scholar 

  14. Ward M, Minto G, Alexander-Williams JM. A comparison of patient-controlled analgesia administered by the intravenous or intranasal route during the early postoperative period. Anesthesia. 2002;57:48.

    Article  CAS  Google Scholar 

  15. Ilfeld BM, Le LT, Meyer RS, Mariano ER, Vandenborne K, Duncan PW, Sessler DI, Enneking FK, Shuster JJ, Theriaque DW, Berry LF, Spadoni EH, Gearen PF. Ambulatory continuous femoral nerve blocks decrease time to discharge readiness after tricompartment total knee arthroplasty: a randomized, triple-masked, placebo-controlled study. Anesthesiology. 2008;108:703–13.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  16. Ilfeld BM, Mariano ER, Girard PJ, Loland VJ, Meyer RS, Donovan JF, Pugh GA, Le LT, Sessler DI, Shuster JJ, Theriaque DW, Ball ST. A multicenter, randomized, triple-masked, placebo-controlled trial of the effect of ambulatory continuous femoral nerve blocks on discharge-readiness following total knee arthroplasty in patients on general orthopaedic wards. Pain. 2010;150:477–84.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Abdallah FW, Brull R. Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? A systematic review. Reg Anesth Pain Med 2011;36(5):493–498.

    Google Scholar 

  18. Fischer HB, Simanski CJ, Sharp C, Bonnet F, Camu F, Neugebauer EA, Rawal N, Joshi GP, Schug SA, Kehlet H, PROSPECT Working Group. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia. 2008;63:1105–23.

    Article  PubMed  CAS  Google Scholar 

  19. Wegener JT, Dijk NV, Hollmann MW, Preckel B, Stevens MF. Value of single-injection or continuous sciatic nerve block in addition to a continuous femoral nerve block in patients undergoing total knee arthroplasty: a prospective, randomized, controlled trial. Reg Anesth Pain Med. 2011;36:481–8.

    Article  PubMed  Google Scholar 

  20. Mariano ER, Cheng GS, Choy LP, Loland VJ, Bellars RH, Sandhu NS, Bishop ML, Lee DK, Maldonado RC, Ilfeld BM. Electrical stimulation versus ultrasound guidance for popliteal-sciatic perineural catheter insertion: a randomized controlled trial. Reg Anesth Pain Med. 2009;34:480–5.

    Article  PubMed  Google Scholar 

  21. Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg 2011;113(4):904–925

    Google Scholar 

  22. Brull R, McCartney CJ, Chan VW, El Beheiry H. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007;104:965–74.

    Article  PubMed  Google Scholar 

  23. Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop. 2008;79:174–83.

    Article  PubMed  Google Scholar 

  24. Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, Varin F. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am. 2006;88:282–9.

    Article  PubMed  Google Scholar 

  25. Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, Rorabeck CH, McCalden RW. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am. 2006;88:959–63.

    Article  PubMed  Google Scholar 

  26. Carli F, Clemente A, Asenjo JF, Kim DJ, Mistraletti G, Gomarasca M, Morabito A, Tanzer M. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs. continuous femoral nerve block. Br J Anaesth. 2010;105(2):185–95.

    Article  PubMed  CAS  Google Scholar 

  27. Brill S, Plaza M. Non-narcotic adjuvants may improve the duration and quality of analgesia after knee arthroscopy: a brief review. Can J Anaesth. 2004;51:975–8.

    Article  PubMed  Google Scholar 

  28. Murphy TP, Byrne DP, Curtin P, Baker JF, Mulhall KJ. Can a periarticular levobupivacaine injection reduce postoperative opiate consumption during primary hip arthroplasty? Clin Orthop Relat Res. 2012;470:1151–7.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Rømsing J, Møiniche S, Ostergaard D, Dahl JB. Local infiltration with NSAIDs for postoperative analgesia: evidence for a peripheral analgesic action. Acta Anaesthesiol Scand. 2000;44(6):672–83.

    Article  PubMed  Google Scholar 

  30. Spreng UJ, Dahl V, Hjall A, Fagerland MW, Ræder J. High-volume local infiltration analgesia combined with intravenous or local ketorolac + morphine compared with epidural analgesia after total knee arthroplasty. Br J Anaesth. 2010;105(5):675–82.

    Article  PubMed  CAS  Google Scholar 

  31. Essving P, Axelsson K, Kjellberg J, Wallgren O, Gupta A, Lundin A. Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty. Acta Orthop 2010;81(3):354–360.

    Google Scholar 

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Acknowledgments

No external funding or conflicts of interest are declared.

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Authors and Affiliations

  1. Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan

    Eri Gi, Masanori Yamauchi & Michiaki Yamakage

  2. Department of Anesthesiology, Obihiro Kyokai Hospital, Obihiro, Japan

    Chiharu Kikuchi & Hitoshi Shimizu

  3. Department of Orthopaedic Surgery, Obihiro Kyokai Hospital, Obihiro, Japan

    Yohei Okada, Shuji Kawamura & Tomoyuki Suzuki

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  1. Eri Gi
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  2. Masanori Yamauchi
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  4. Chiharu Kikuchi
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Correspondence to Eri Gi.

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Gi, E., Yamauchi, M., Yamakage, M. et al. Effects of local infiltration analgesia for posterior knee pain after total knee arthroplasty: comparison with sciatic nerve block. J Anesth 28, 696–701 (2014). https://doi.org/10.1007/s00540-014-1793-y

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  • DOI: https://doi.org/10.1007/s00540-014-1793-y

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