Abstract
Background:
Pain after total knee arthroplasty (TKA) is a big problem in orthopaedic surgery. Although opioids and continuous epidural analgesia remain the major options for the postoperative pain management of TKA, they have some undesirable side effects. Epidural analgesia is technically demanding, and the patient requires close monitoring. Different types of local anesthetic applications can successfully treat TKA pain. Local anesthetics have the advantage of minimizing pain at the source. This study investigates the efficacy of different local anesthetic application methods on early, (1st day) pain control after total knee arthroplasty.
Materials and Methods:
200 patients who underwent unilateral TKA surgery under spinal anesthesia were randomly assigned into four different groups (fifty in each group) and were administered pain control by different peri- and postoperative regimens. Group A was the control group wherein no postsurgical analgesia was administered to assess spinal anesthesia efficacy; in Group B, only postsurgical one-shot femoral block was applied; in Group C, intraoperative periarticular local anesthetic was applied; in Group D, a combination of the one-shot femoral block and intraoperative periarticular local anesthetics were applied. Demographic data consisting of age, weight, gender and type of deformity of patients were collected. The data did not differ significantly between the four groups.
Results:
Group D patients experienced significantly better postoperative pain relief (P < 0.05) and were therefore more relaxed in pain (painless time, VAS score) and knee flexion (degrees) than the other patient groups in the 1st postoperative day followup. Painless time of Group D was 10.5 hours and was better than Group C (6.8 hours), Group B (6.2 hours) and Group A (3.0 hours) (P < 0.05). Group A got the best pain Vas score degrees in the 1st postoperative day which showed the success of combined periarticülar local anesthetic injection and femoral nerve block.
Conclusion:
The intraoperative periarticular application of local anesthetics in addition to one-shot femoral block is an efficient way of controlling postsurgical pain after TKA.
Similar content being viewed by others
References
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.
Ganapathy S, Wasserman RA, Watson JT, Bennett J, Armstrong KP, Stockall CA, et al. Modified continuous femoral three-in-one block for postoperative pain after total knee arthroplasty. Anesth Analg 1999;89:1197–202.
Badner NH, Bourne RB, Rorabeck CH, MacDonald SJ, Doyle JA. Intraarticular injection of bupivacaine in knee-replacement operations. Results of use for analgesia and for preemptive blockade. J Bone Joint Surg Am 1996;78:734–8.
Allen HW, Liu SS, Ware PD, Nairn CS, Owens BD. Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg 1998;87:93–7.
Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, et al. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 2006;88:282–9.
Richman JM, Liu SS, Courpas G, Wong R, Rowlingson AJ, McGready J, et al. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg 2006;102:248–57.
Kardash K, Hickey D, Tessler MJ, Payne S, Zukor D, Velly AM. Obturator versus femoral nerve block for analgesia after total knee arthroplasty. Anesth Analg 2007;105:853–8.
Sato K, Sai S, Shirai N, Adachi T. Ultrasound guided obturator versus sciatic nerve block in addition to continuous femoral nerve block for analgesia after total knee arthroplasty. Jpn Clin Med 2011;2:29–34.
Röstlund T, Kehlet H. High-dose local infiltration analgesia after hip and knee replacement – What is it, why does it work, and what are the future challenges? Acta Orthop 2007;78:159.
Robards C, Wang RD, Clendenen S, Ladlie B, Greengrass R. Sciatic nerve catheter placement: Success with using the Raj approach. Anesth Analg 2009;109:972–5.
Martin F, Martinez V, Mazoit JX, Bouhassira D, Cherif K, Gentili ME, et al. Antiinflammatory effect of peripheral nerve blocks after knee surgery: Clinical and biologic evaluation. Anesthesiology 2008;109:484–90.
Lombardi AV Jr., Berend KR, Mallory TH, Dodds KL, Adams JB. Soft tissue and intraarticular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res 2004;428:125–30.
Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 2006;88:959–63.
Kim MH, Nahm FS, Kim TK, Chang MJ, Do SH. Comparison of postoperative pain in the first and second knee in staged bilateral total knee arthroplasty: Clinical evidence of enhanced pain sensitivity after surgical injury. Pain 2014;155:22–7.
Liu Q, Chelly JE, Williams JP, Gold MS. Impact of peripheral nerve block with low dose local anesthetics on analgesia and functional outcomes following total knee arthroplasty: A retrospective study. Pain Med 2015;16:998–1006.
Ng FY, Ng JK, Chiu KY, Yan CH, Chan CW. Multimodal periarticular injection vs continuous femoral nerve block after total knee arthroplasty: A prospective, crossover, randomized clinical trial. J Arthroplasty 2012;27:1234–8.
Yadeau JT, Goytizolo EA, Padgett DE, Liu SS, Mayman DJ, Ranawat AS, et al. Analgesia after total knee replacement: Local infiltration versus epidural combined with a femoral nerve blockade: A prospective, randomised pragmatic trial. Bone Joint J 2013;95-B: 629–35.
Ben-David B, Schmalenberger K, Chelly JE. Analgesia after total knee arthroplasty: Is continuous sciatic blockade needed in addition to continuous femoral blockade? Anesth Analg 2004;98:747–9.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Rights and permissions
About this article
Cite this article
Sigirci, A. Pain management in total knee arthroplasty by intraoperative local anesthetic application and one-shot femoral block. IJOO 51, 280–285 (2017). https://doi.org/10.4103/0019-5413.205688
Published:
Issue Date:
DOI: https://doi.org/10.4103/0019-5413.205688