Additional benefit of local infiltration of analgesia to femoral nerve block in total knee arthroplasty: double-blind randomized control study

  • Koji AsoEmail author
  • Masashi Izumi
  • Natsuki Sugimura
  • Yusuke Okanoue
  • Yuko Kamimoto
  • Masataka Yokoyama
  • Masahiko Ikeuchi



Multimodal analgesia has become an important concept in current pain management following total knee arthroplasty (TKA). However, controversy remains over what is the most accepted combination. In this study, the additional benefits of local infiltration of analgesia to femoral nerve block were evaluated.


Forty patients were randomly allocated into a combined local infiltration of analgesia and femoral nerve block or femoral nerve block alone group. In the former, analgesic drugs consisting of ropivacaine and dexamethasone were injected into the peri-articular tissues, while the same amount of saline was injected into the femoral nerve block group. The primary outcome measure was the total amount of fentanyl consumption by the patient-controlled analgesia pump during the 48-h post-operative period.


A combination of local infiltration of analgesia and femoral nerve block had less total fentanyl consumption and a larger knee ROM at post-operative day 2 than femoral nerve block alone (p < 0.05). C-reactive protein levels in the combined treatment group were significantly lower than the femoral nerve block group at post-operative day 3 (p < 0.01). There was no difference between the two groups, post-operatively, on the visual analogue scale for pain at rest or while walking, quadriceps strength, timed up and go test, circumference of thigh, Knee Society Score, and Western Ontario and McMaster Universities Osteoarthritis Index.


The addition of local infiltration of analgesia to femoral nerve block promoted post-operative pain relief and the recovery of knee ROM in the early post-operative period. This combination is an effective method for post-operative pain management after TKA.

Level of evidence

Randomized controlled trial, Level I.


Total knee arthroplasty Post-operative pain Local infiltration of analgesia Femoral nerve block Randomized controlled trial 



We express our sincere gratitude to all patients who participated in this study.

Author contributions

KA and MI designed the experiments, analyzed and interpreted the results, and wrote the manuscript. KA, NS, MI and MI performed the surgery. YK and MY administered the anaesthesia and post-operative pain management. NS and YO analyzed and interpreted the results. MI directed the study.


There is no funding source.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest associated with this study.

Ethical approval

All procedures used in this research were approved by the Ethical Review Board of Kochi Medical School (IRB number 24-113).


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Kochi Medical SchoolKochi UniversityNankokuJapan
  2. 2.Department of Anaesthesiology, Kochi Medical School, Japan Kochi Medical SchoolKochi UniversityNankokuJapan

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