Abstract
BackgroundPostoperative pain control and enhanced mobilization, muscle strength and range of motion following total knee arthroplasty (TKA) are pivotal requisites to optimize rehabilitation and early recovery. The aim of the study was to analyze the effect of local infiltration analgesia (LIA), peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in primary total knee arthroplasty.MethodsBetween January 2016 until August 2016, 280 patients underwent primary TKA and were subdivided into four groups according to their concomitant pain and anesthetic procedure with catheter-based techniques of femoral and sciatic nerve block (group GA&FNB, n = 81) or epidural catheter (group SP&EPI, n = 51) in combination with general anesthesia or spinal anesthesia, respectively, and LIA combined with general anesthesia (group GA&LIA, n = 86) or spinal anesthesia (group SP&LIA, n = 61). Outcome parameters focused on the evaluation of pain (NRS scores), mobilization, muscle strength and range of motion up to 7 days postoperatively. The cumulative consumption of (rescue) pain medication was analyzed.ResultsPain relief was similar in all groups, while the use of opioid medication was significantly lower (up to 58%) in combination with spinal anesthesia, especially in SP&EPI. The LIA groups, in contrast, revealed significant higher mobilization (up to 26%) and muscle strength (up to 20%) in the early postoperative period. No analgesic technique-related or surgery-related complications occurred within the first 7 days. Due to insufficient pain relief, 8.4% of the patients in the catheter-based groups and 12.2% in the LIA groups resulted in a change of the anesthetics pain management.ConclusionsThe LIA technique offers a safe and effective treatment option concerning early functional recovery and pain control in TKA. Significant advantages were shown for mobilization and muscle strength in the early postoperative period while pain relief was comparable within the groups.
Highlights
Postoperative pain control and enhanced mobilization, muscle strength and range of motion following total knee arthroplasty (TKA) are pivotal requisites to optimize rehabilitation and early recovery
The aim of the study was to analyze the effect of femoral nerve block and general anesthesia, epidural catheter and spinal anesthesia, local infiltration analgesia (LIA) combined with general anesthesia and spinal anesthesia, respectively, on early functional recovery and pain control in primary TKA
In GA&femoral nerve blocks (FNB), 4.9% (n = 4) patients received a patient-controlled intravenous analgesia (PCIA) with an initial bolus of 4 mg piritramide followed by an optional bolus of 2 mg piritramide with a lockout of 10 min
Summary
Postoperative pain control and enhanced mobilization, muscle strength and range of motion following total knee arthroplasty (TKA) are pivotal requisites to optimize rehabilitation and early recovery. The aim of the study was to analyze the effect of local infiltration analgesia (LIA), peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in primary total knee arthroplasty. The primary goals of peri- and postoperative analgesic treatment are to reduce pain and immobilization and to minimize opioid requirements and opioid-related adverse events. Enhancing these outcomes has a potential beneficial influence on patient morbidity and satisfaction, the degree of required postoperative care, as well as economic perspectives. Several peri- and postoperative pain control strategies have been established in the last years including peripheral nerve blocks, epidural analgesia as well as local infiltration analgesia (LIA) and (systemic) opioids [1]
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