, Volume 471, Issue 7, pp 2284-2295
Date: 21 Mar 2013

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

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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.

Results

Opioid consumption was lower in the PAI group during the first 8 postoperative hours (12.5 mg versus 18.7 mg morphine), as was reported pain at rest (1.7 versus 3.5 on a 10-point VAS). Thereafter, narcotic consumption and reported pain were similar up to 120 hours. More subjects in the femoral nerve block group experienced quadriceps motor block (37% versus 0% in the PAI group). On Days 1 to 3, subjects in the PAI group experienced better capacity to perform the straight leg raise, active knee extension, and had longer walking distances.

Conclusions

PAI provided pain control equivalent to that of a femoral nerve block while avoiding a motor block and its negative functional impacts. The data suggest it should be considered an alternative to a femoral nerve block.

Level of Evidence

Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

One of the authors (ML) has received payments or benefits not related to this work, during the study period, an amount of USD 10,000–USD 100,000 from Wright Medical Technology (Memphis, TN, USA) and Zimmer (Warsaw, IN, USA). One of the authors (P-AV) has received payments or benefits not related to this work, during the study period, an amount of USD 10,000–USD 100,000 from Wright Medical, Biomet (Warsaw, IN, USA), and Stryker Orthopaedics (Mahwah, NJ, USA). The institution of one or more of the authors (PAV, ML, DA, PD) has received, during the study period, unrestricted research funding not related to this work from Biomet, Zimmer, Stryker, Smith and Nephew (Memphis, TN, USA), and DePuy Orthopaedics (Warsaw, IN, USA).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
Randomization, surgical procedures, and followup of the subjects were performed at Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.
An erratum to this article can be found at http://dx.doi.org/10.1007/s11999-013-2970-2.