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Clinical Orthopaedics and Related Research®

, Volume 468, Issue 5, pp 1242–1247 | Cite as

Postoperative Analgesia in TKA: Ropivacaine Continuous Intraarticular Infusion

  • Primitivo Gómez-CarderoEmail author
  • E. Carlos Rodríguez-Merchán
Symposium: Current Issues in Knee Reconstruction

Abstract

Background

Postoperative pain control is a challenge in patients undergoing TKA due to side effects and technical limitations of current analgesic approaches. Local anesthetic infiltration through continuous infusion pumps has been shown to reduce postoperative pain in previous studies.

Questions/purposes

We assessed the effectiveness of intraarticular ropivacaine infusions in reducing pain and postoperative opioid use after TKA and determined whether such infusions accelerate functional recovery of the patient and reduce length of hospital stay.

Methods

In a randomized, prospective, double-blind study, two groups were assigned: Group A (n = 25) underwent continuous intraarticular infusion with 300 mL ropivacaine 0.2% at a speed of 5 mL/hour through an elastomeric infusion pump and Group B (n = 25) had an elastomeric pump insertion with 300 mL saline solution at an infusion speed of 5 mL/hour. All patients had the same prosthesis model implanted. Parameters analyzed over the first 3 days, at discharge, and 1 month later included postoperative pain, joint function, opioid use, and length of hospital stay.

Results

All patients in Group A showed a decrease in pain intensity measured by a visual analog scale and opioid use in the first 3 days. Mean length of hospital stay was also reduced in Group A (5.72 days) compared to Group B (7.32 days). There were no device-related complications.

Conclusions

Use of an infusion pump is effective in treating pain after TKA, reducing postoperative pain and opioid use. It also improves immediate functionality and patient comfort, reducing the mean length of hospital stay, without increasing the risk of complications.

Level of Evidence

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

Keywords

Morphine Postoperative Pain Bupivacaine Ropivacaine Ketorolac 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Alford JW, Fadale PD. Evaluation of postoperative bupivacaine infusion for pain management after anterior cruciate ligament reconstruction. Arthroscopy. 2003;19:855–861.CrossRefPubMedGoogle Scholar
  2. 2.
    Baeza Gil C. Postoperative pain control in prosthetic knee replacement surgery [in Spanish]. In: Ortega Andreu M, Rodríguez Merchán EC, eds. Recambios Protésicos de Rodilla. Madrid, Spain: Ed Panamericana; 2001:35–50.Google Scholar
  3. 3.
    Beaussier M. Frequency, intensity, development and repercussions of postoperative pain as a function of the type of surgery [in French]. Ann Fr Anesth Réanim. 1998;17:471–493.PubMedGoogle Scholar
  4. 4.
    Bianconi M, Ferraro L, Traina GC, Zanoli G, Antonelli T. Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery. Br J Anaesth. 2003;91:830–835.CrossRefPubMedGoogle Scholar
  5. 5.
    Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA. 2003;290:2455–2463.CrossRefPubMedGoogle Scholar
  6. 6.
    Brasseur L, Boukhatem P. The epidemiology of postoperative pain [in French]. Ann Fr Anesth Réanim. 1998;17:534–539.PubMedGoogle Scholar
  7. 7.
    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;88:959–963.CrossRefPubMedGoogle Scholar
  8. 8.
    Colwell CW Jr. The use of the pain pump and patient-controlled analgesia in joint reconstruction. Am J Orthop. 2004;33(5 Suppl):10–12.PubMedGoogle Scholar
  9. 9.
    DeWeese FT, Akbari Z, Carline E. Pain control after knee arthroplasty: intraarticular versus epidural anesthesia. Clin Orthop Relat Res. 2001;392:226–231.CrossRefPubMedGoogle Scholar
  10. 10.
    Gottschalk A, Burmeister MA, Radtke P, Krieg M, Farokhzad F, Kreissl S, Strauss M, Standl T. Continuous wound infiltration with ropivacaine reduces pain and analgesic requirement after shoulder surgery. Anesth Analg. 2003;97:1086–1091.CrossRefPubMedGoogle Scholar
  11. 11.
    Hahnenkamp K, Theilmeier G, Van Aken HK, Hoenemann CW. The effects of local anesthetics on perioperative coagulation, inflammation, and microcirculation. Anesth Analg. 2002;94:1441–1447.CrossRefPubMedGoogle Scholar
  12. 12.
    Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology. 2000;93:858–875.CrossRefPubMedGoogle Scholar
  13. 13.
    Horlocker TT, Hebl JR, Kinney MA, Cabanela ME. Opioid-free analgesia following total knee arthroplasty—a multimodal approach using continuous lumbar plexus (psoas compartment) block, acetaminophen, and ketorolac. Reg Anesth Pain Med. 2002;27:105–108.PubMedGoogle Scholar
  14. 14.
    Isaac D, Falode T, Liu P, I’Anson H, Dillow K, Gill P. Accelerated rehabilitation after total knee arthroplasty replacement. Knee. 2005;12:346–350.CrossRefPubMedGoogle Scholar
  15. 15.
    Johnson SM, Saint John BE, Dine AP. Local anesthetics as antimicrobial agents: a review. Surg Infect (Larchmt). 2008;9:205–213.CrossRefGoogle Scholar
  16. 16.
    Maheshwari AV, Blum YC, Sherkhart L Ranawat AS, Ranawat CS. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res. 2009;467:1418–1423.CrossRefPubMedGoogle Scholar
  17. 17.
    Nechleba J, Rogers V, Cortina G, Cooney T. Continuous intra-articular infusion of bupivacaine for postoperative pain following total knee arthroplasty. J Knee Surg. 2005;18:197–202.PubMedGoogle Scholar
  18. 18.
    Perkins FM, Kehlet H. Chronic pain as an outcome of surgery: a review of predictive factors. Anesthesiology. 2000;93:1123–1133.CrossRefPubMedGoogle Scholar
  19. 19.
    Rasmussen S, Kramhøft MU, Sperling KP, Pedersen JH. Increased flexion and reduced hospital stay with continuous intraarticular morphine and ropivacaine after primary total knee replacement: open intervention study of efficacy and safety in 154 patients. Acta Orthop Scand. 2004;75:606–609.CrossRefPubMedGoogle Scholar
  20. 20.
    Skinner HB. Multimodal acute pain management. Am J Orthop. 2004;33(5 Suppl):5–93.PubMedGoogle Scholar
  21. 21.
    Stringer BW, Singhania AK, Sudhakar JE, Brink RB. Serum and wound drain ropivacaine concentrations after wound infiltration in joint arthroplasty. J Arthroplasty. 2007;22:884–892.CrossRefPubMedGoogle Scholar
  22. 22.
    Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tonnesen EK, Soballe K. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop. 2007;78:172–179.CrossRefPubMedGoogle Scholar
  23. 23.
    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;88:282–289.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Primitivo Gómez-Cardero
    • 1
    • 2
    Email author
  • E. Carlos Rodríguez-Merchán
    • 1
  1. 1.Knee Division, Department of OrthopedicsLa Paz University HospitalMadridSpain
  2. 2.MadridSpain

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