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Perspectives: Best Techniques for Local Wound Infiltrations

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Perioperative Medical Management for Total Joint Arthroplasty

Abstract

Total knee arthroplasty (TKA) is a successful procedure but can be painful or at least confers a high risk of severe acute postoperative pain. This pain may cause delayed rehabilitation, extended hospital stay, and persistent postoperative pain. A number of traditional peri-operative analgesic approaches, such as postoperative intravenous opioids, epidurals, and peripheral nerve blocks are relied upon to achieve pain control after TKA, despite well-known side-effects and sometimes even debilitating complications. To minimise the necessity for opioids and maximise pain control, multimodal analgesia has been suggested. However, issues remain, which has increased the interest in a relatively novel technique – local infiltration analgesia (LIA). This promising technique involves the infiltration of a local anaesthetic or a mixture (cocktail) into the surgical wound during TKA by the surgeon. LIA is easy to use, safe and inexpensive, and has been widely adopted as part of multimodal pain management and early mobilisation protocols. There have been a number of studies into the effectiveness of LIA. These have yielded mixed results, potentially because of the lack of consensus over the optimal LIA technique; with wide variations in the mixture, concentration, volume of analgesics administered and the location of infiltration. An anatomical knee block that follows the principles of pain and pain control in TKA via a step-by-step approach may offer improved outcomes. In conclusion, LIA is an attractive technique because of its simplicity and safety. Further, well-designed studies will be required to confirm its potential and determine the optimal usage.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Hospital Saint Luc, Av. Hippocrate 10, Brussels, 1200, Belgium

    Emmanuel Thienpont

  2. Hip and Knee Arthroplasty and Arthroscopic Unit, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milan, 20089, Italy

    Francesco Traverso

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  1. Emmanuel Thienpont
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Correspondence to Emmanuel Thienpont or Francesco Traverso .

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  1. Humanitas Clinical and Research Center, Milan, Italy

    Andrea Baldini

  2. San Donato Hospital, Arezzo, Italy

    Patrizio Caldora

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Thienpont, E., Traverso, F. (2015). Perspectives: Best Techniques for Local Wound Infiltrations. In: Baldini, A., Caldora, P. (eds) Perioperative Medical Management for Total Joint Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-07203-6_17

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