Skip to main content

Advertisement

Log in

Infiltrationstechniken

Local infiltration anesthesia

  • Operative Techniken: Standards
  • Published:
Knie Journal Aims and scope

Zusammenfassung

Die Knieendoprothetik ist eine erfolgreiche Operation im Bereich der orthopädischen Chirurgie, die allerdings mit einem hohen perioperativen Schmerzniveau einhergeht [14]. Als Teil eines Schmerzkonzepts hat sich die lokale Infiltrationsanästhesie (LIA) etabliert und wird empfohlen [16]. Ziel einer guten Schmerztherapie ist, die postoperative Mobilisation und das funktionelle Ergebnis nicht zu beeinträchtigen. Damit sollen eine verzögerte Rehabilitation und längere Hospitalisierung mit entsprechenden Risiken sowie höhere Kosten vermieden werden.

Abstract

Total knee arthroplasty is a successful procedure of orthopedic surgery. However it is associated with significant postoperative pain that is difficult to treat [14]. As part of successful pain management local infiltration analgesia (LIA) is established and recommended [16]. An elaborate pain management strategy prevents delayed postoperative mobilization and unsatisfactory functional results. Increased length of hospital stay accompanied with relevant risks and higher costs can be prevented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. Andersen KV, Nikolajsen L, Daugaard H, Andersen NT, Haraldsted V, Søballe K (2015) Local infiltration analgesia is not improved by postoperative intra-articular bolus injections for pain after total hip arthroplasty. Acta Orthop 86:647–653. https://doi.org/10.3109/17453674.2015.1081340

    Article  PubMed  PubMed Central  Google Scholar 

  2. Andersen KV, Nikolajsen L, Haraldsted V, Odgaard A, Søballe K (2013) Local infiltration analgesia for total knee arthroplasty: should ketorolac be added? Br J Anaesth 111(2):242–248. https://doi.org/10.1093/bja/aet030

    Article  CAS  PubMed  Google Scholar 

  3. Bakker SMK, Fenten MGE, Touw DJ, van den Bemt BJF, Heesterbeek PJC, Scheffer GJ, Stienstra R (2018) Pharmacokinetics of 400 mg locally infiltrated ropivacaine after total knee arthroplasty without perioperative tourniquet use. Reg Anesth Pain Med 43(7):699–704. https://doi.org/10.1097/AAP.0000000000000816

    Article  CAS  PubMed  Google Scholar 

  4. Ben-David B, Schmalenberger K, Chelly JE (2004) Analgesia after total knee arthroplasty: is continuous sciatic blockade needed in addition to continuous femoral blockade? Anesth Analg 98:747–749

    Article  PubMed  Google Scholar 

  5. 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 Joint Surg Am 88(5):959–963. https://doi.org/10.2106/JBJS.E.00344

    Article  PubMed  Google Scholar 

  6. Chareancholvanich K, Tantithawornwat S, Ruangsomboon P, Narkbunnam R, Chatmaitri S, Pornrattanamaneewong C (2023) Efficacy of epinephrine in local infiltration analgesia on pain relief and opioid consumption following total knee arthroplasty: a randomized controlled trial. Acta Orthop 94:97–101. https://doi.org/10.2340/17453674.2023.8482

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fowler SJ, Symons J, Sabato S, Myles PS (2008) Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth 100:154–164. https://doi.org/10.1093/bja/aem373

    Article  CAS  PubMed  Google Scholar 

  8. Fu P, Wu Y, Wu H, Li X, Qian Q, Zhu Y (2009) Efficacy of intra-articular cocktail analgesic injection in total knee arthroplasty—a randomized controlled trial. Knee 16(4):280–284. https://doi.org/10.1016/j.knee.2008.12.012

    Article  PubMed  Google Scholar 

  9. Gromov K, Grassin-Delyle S, Foss NB, Pedersen LM, Nielsen CS, Lamy E, Troelsen A, Urien S, Husted H (2021) Population pharmacokinetics of ropivacaine used for local infiltration anaesthesia during primary total unilateral and simultaneous bilateral knee arthroplasty. Br J Anaesth 126:872–880

    Article  CAS  PubMed  Google Scholar 

  10. Grosu I, Lavand’homme P, Thienpont E (2014) Pain after knee arthroplasty: an unresolved issue. Knee Surg Sports Traumatol Arthrosc 22:1744–1758

    Article  PubMed  Google Scholar 

  11. Hussain N, Brull R, Sheehy BT, Kushelev M, Essandoh MK, Abdallah FW (2021) The mornings after-periarticular liposomal bupivacaine infiltration does not improve analgesic outcomes beyond 24 h following total knee arthroplasty: a systematic review and meta-analysis. Reg Anesth Pain Med 46:61–72. https://doi.org/10.1136/rapm-2020-101995

    Article  PubMed  Google Scholar 

  12. Hube R, Mayr HO, von Roth P, Najfeld M, Thiele K (2018) Perioperative management in total knee arthroplasty. Z Orthop Unfall 156:41–45. https://doi.org/10.1055/s-0043-119897

    Article  PubMed  Google Scholar 

  13. Ilfeld BM, Eisenach JC, Gabriel RA (2021) Clinical effectiveness of liposomal bupivacaine administered by infiltration or peripheral nerve block to treat postoperative pain. Anesthesiology 134:283–344

    Article  CAS  PubMed  Google Scholar 

  14. Joshi GP, Van de Velde M, Kehlet H, PROSPECT Working Group Collaborators (2019) Development of evidence-based recommendations for procedure-specific pain management: PROSPECT methodology. Anaesthesia 74:1298–1304

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. 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(2):174–183

    Article  PubMed  Google Scholar 

  16. Lavand’homme PM, Kehlet H, Rawal N, Joshi GP (2022) Pain management after total knee arthroplasty. PROcedure SPEcific Postoperative Pain Management recommendations. Eur J Anaesthesiol 39(9):743–757. https://doi.org/10.1097/EJA.0000000000001691

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Meier M, Sommer S, Huth J, Benignus C, Thienpont E, Beckmann J (2021) Local infiltration analgesia with additional intraarticular catheter provide better pain relief compared to single-shot local infiltration analgesia in TKA. Arch Orthop Trauma Surg 141(1):105–111. https://doi.org/10.1007/s00402-020-03606-0

    Article  PubMed  Google Scholar 

  18. Reilly KA, Beard DJ, Barker KL, Dodd CAF, Price AJ, Murray DW (2005) Efficacy of an accelerated recovery protocol for Oxford unicompartmental knee arthroplasty—a randomised controlled trial. Knee 12(5):351–357. https://doi.org/10.1016/j.knee.2005.01.002

    Article  CAS  PubMed  Google Scholar 

  19. Sinatra RS, Torres J, Bustos AM (2002) Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg 10:117–129

    Article  PubMed  Google Scholar 

  20. Schotanus MGM, Bemelmans YFL, van der Kuy PHM, Jansen J, Kort NP (2015) No advantage of adrenaline in the local infiltration analgesia mixture during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 82:441–446. https://doi.org/10.1007/s00167-015-3723-4

    Article  Google Scholar 

  21. Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, Varin F (2006) A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 88(2):282–289. https://doi.org/10.2106/JBJS.E.00173

    Article  PubMed  Google Scholar 

  22. Zhang Z, Shen B (2018) Effectiveness and weakness of local infiltration analgesia in total knee arthroplasty: a systematic review. J Int Med Res 46(12):4874–4884. https://doi.org/10.1177/0300060518799616

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Clemens Baier.

Ethics declarations

Interessenkonflikt

C. Baier und K. Ascher geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

Steffen Schröter, Siegen

figure qr

QR-Code scannen & Beitrag online lesen

Supplementary Information

Lokale Infiltrationsanästhesie der posterioren Kapsel im Rahmen der Knie-TEP-Implantation. © Mit freundlicher Genehmigung der Autoren, alle Rechte vorbehalten.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baier, C., Ascher, K. Infiltrationstechniken. Knie J. 5, 186–189 (2023). https://doi.org/10.1007/s43205-023-00222-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43205-023-00222-x

Schlüsselwörter

Keywords

Navigation