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Additional periarticular catheter shows no superiority over single-shot local infiltration analgesia alone in unicondylar knee replacement

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Local infiltration analgesia (LIA) has attracted growing interest in recent years. To prolong the positive effects of LIA, a continuous intraarticular perfusion has been introduced in total knee arthroplasty with good clinical results. The purpose of the present study was to evaluate if similar results can be obtained with the use of a continuous periarticular perfusion in unicondylar knee arthroplasty (UKA).

Methods

50 consecutively selected patients undergoing UKA received either a single-shot LIA (control group; n = 25) or single-shot LIA combined with a continuous postoperative periarticular perfusion for 2 postoperative days (intervention group, n = 25). VAS (visual analogue scale) for pain, pain medication consumption and range of flexion were recorded postoperatively for 6 days. The catheter was removed after 2 days.

Results

Only minor advantages of using a continuous periarticular catheter could be shown. Patients in the intervention group showed significant lower VAS scores on day 1 and required significant less pain medication on day 6. Further, there was a significant difference in the range of flexion on day 3, on which patients of the intervention group were able to bend the knee joint on average by 12° more than patients of the control group. On the other days, any significant differences between the two groups were not observed.

Conclusion

In summary, the present study could not identify any superiority of a periarticular catheter over single-shot LIA in UKA. Because of additional costs and the potential risk of infection, the conclusion of this study is to not recommend adding a periarticular catheter to the single-shot LIA in UKA.

Level of evidence

II

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Abbreviations

UKA:

Unicondylar knee arthroplasty

LIA:

Local infiltration analgesia

VAS:

Visual analogue scale

ROM:

Range of motion

LMWHs:

Low-molecular-weight heparins

References

  1. Ali A, Sundberg M, Hansson U, Malmvik J, Flivik G (2015) Doubtful effect of continuous intraarticular analgesia after total knee arthroplasty: a randomized double-blind study of 200 patients. Acta Orthop 86:373–377

    Article  Google Scholar 

  2. Bakker SMK, Fenten MGE, Touw DJ, van den Bemt BJF, Heesterbeek PJC, Scheffer G-J, Stienstra R (2018) Pharmacokinetics of 400 mg locally infiltrated ropivacaine after total knee arthroplasty without perioperative tourniquet use. Reg Anesth Pain Med 43:699–704

    CAS  PubMed  Google Scholar 

  3. Blendon RJ, Benson JM (2018) The public and the opioid-abuse epidemic. N Engl J Med 378:407–411

    Article  Google Scholar 

  4. Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, Rorabeck CH, McCalden RW (2006) Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Jt Surg Am 88:959–963

    Article  Google Scholar 

  5. Dillon JP, Brennan L, Mitchell D (2012) Local infiltration analgesia in hip and knee arthroplasty: an emerging technique. Acta Orthop Belg 78:158–163

    PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

  7. Fenten MGE, Bakker SMK, Touw DJ, van den Bemt BJF, Scheffer GJ, Heesterbeek PJC, Stienstra R (2017) Pharmacokinetics of 400 mg ropivacaine after periarticular local infiltration analgesia for total knee arthroplasty. Acta Anaesthesiol Scand 61:338–345

    Article  CAS  Google Scholar 

  8. Gómez-Cardero P, Rodríguez-Merchán EC (2010) Postoperative analgesia in TKA: ropivacaine continuous intraarticular infusion. Clin Orthop 468:1242–1247

    Article  Google Scholar 

  9. Horlocker TT (2010) Pain management in total joint arthroplasty: a historical review. Orthopedics 33:14–19

    Article  Google Scholar 

  10. Kerr DR, Kohan L (2008) 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 79:174–183

    Article  Google Scholar 

  11. Knudsen K, Beckman Suurküla M, Blomberg S, Sjövall J, Edvardsson N (1997) Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 78:507–514

    Article  CAS  Google Scholar 

  12. Manchikanti L, Helm S, Fellows B, Janata JW, Pampati V, Grider JS, Boswell MV (2012) Opioid epidemic in the United States. Pain Phys 15:ES9–38

    Google Scholar 

  13. Puolakka PAE, Rorarius MGF, Roviola M, Puolakka TJS, Nordhausen K, Lindgren L (2010) Persistent pain following knee arthroplasty. Eur J Anaesthesiol 27:455–460

    Article  Google Scholar 

  14. Schwab P-E, Yombi J, Lavand’homme P, Thienpont E, (2019) Comparison of local infiltration analgesia with single injection femoral nerve block in total knee arthroplasty. Acta Orthop Belg 85:122–129

    PubMed  Google Scholar 

  15. Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tønnesen EK, Søballe K (2007) Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop 78:172–179

    Article  Google Scholar 

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Funding

No funding was received for the present study.

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Author notes

  1. M. Meier and P. Burkhardt share first authorship.

Authors and Affiliations

  1. Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany

    Malin Meier, Patrick Burkhardt, Jochen Huth, Raymond Best & Johannes Beckmann

  2. Cliniques Universitaires Saint-Luc, Bruxelles, Belgium

    Emmanuel Thienpont

Authors
  1. Malin Meier
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  2. Patrick Burkhardt
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  3. Jochen Huth
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  4. Raymond Best
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  5. Emmanuel Thienpont
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  6. Johannes Beckmann
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Corresponding author

Correspondence to Malin Meier.

Ethics declarations

Conflict of interest

The authors MM, PB, JH, RB declare that they have no conflict of interest. The author ET declares that he is providing consultancies for Convatec, KCI, LIMA, Medacta and Zimmer Biomet. He also declares that he receives royalties from LIMA, Medacta and Zimmer Biomet. He further declares that he is part of the European knee society board. The author JB declares that he has no conflict of interest, receives honoraria from DePuy, Conformis, Pajunk and Smith & Nephew.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the ethic committee of the local state medical council (Approv. No. F-2017-025).

Informed consent

Informed consent was obtained from all individual participants included in this study.

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Meier, M., Burkhardt, P., Huth, J. et al. Additional periarticular catheter shows no superiority over single-shot local infiltration analgesia alone in unicondylar knee replacement. Knee Surg Sports Traumatol Arthrosc 29, 627–632 (2021). https://doi.org/10.1007/s00167-020-05981-y

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  • DOI: https://doi.org/10.1007/s00167-020-05981-y

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