Comparison of Postoperative Epidural Analgesia in the Two Staged Bilateral Total Knee Replacements

Abstract

Background: Modem studies have confirmed that interindividual pain threshold variability greatly exceeds intraindividual pain threshold variability. The purpose of this investigation was to compare the efficacy and safety of postoperative pain control by patient controlled analgesia (PCA) of two staged bilateral total knee replacements in the same patient. Methods: Forty patients had two total knee replacements in separate sessions of anesthesia (a bilateral two stage procedure). They received postoperative pain treatment with patient-controlled epidural analgesia during the first postoperative 48 hours after total knee replacement. The procedures were assigned to the first operation (early group) and the second operation (late group) in the same patient. Visual analog scale (VAS) scores whilst at rest or during movement were used to assess pain. Total bupivacaine volume delivered, number of PCA requests, supplemental analgesics, overall satisfaction score and adverse events were evaluated. Results: No significant differences were found between the two (early and late) groups in terms of effects and adverse events of postoperative pain control. Conclusions: Two staged bilateral total knee replacement appears to be a mans of comparing postoperative pain control, and which significantly reduces interindividual variability.