Abstract
PurposePain management after total knee arthroplasty (TKA) is still under debate. Continuous peripheral nerve blocks (PNB) can provide long pain relief but impair muscle function. Continuous intraarticular analgesia could result in longer pain relief than local infiltration analgesia without negative effects on muscle function. This study investigated the efficacy of pain control between PNB’s and continuous intraarticular analgesia after TKA.MethodsA prospective randomized study on 140 patients undergoing TKA was performed. Patients received either a combination of continuous femoral nerve block, continuous sciatic nerve block and single-shot obturator nerve block (group R) or a local infiltration analgesia and a continuous intraarticular catheter with ropivacaine (group L). Primary outcome was pain measured on a numerical rating scale. Knee function, patient-reported outcome (PRO) and adverse events were assessed until 1 year after surgery.ResultsPain at rest was lower in group R on the day of surgery (mean NRS 3.0 vs. 4.2) and the morning of postoperative day 1 (mean NRS 3.4 vs. 4.4). Motor blockade longer than postoperative day 3 occurred more often in group R compared to group L (15.3% vs. 1.5%). Pain levels, PRO and satisfaction 3-month and 1-year after surgery were similar.ConclusionContinuous PNB’s were slightly more effective in the first 24 h after surgery but were associated more often with motor blockade which should be avoided. It must be balanced if the small amount of better pain relief immediately after surgery justifies the risks associated with motor blockade following PNB’s.Level of evidenceI.
Highlights
Despite total knee arthroplasty (TKA) being considered as one of the most painful surgeries, pain control after surgery is still a challenge and there is currently no generally agreed optimal analgesic regimen after TKA [3, 8, 23]
Over more than 2 decades continuous peripheral nerve blocks (PNB) have been preferentially applied for TKA offering probably the best postoperative pain control, especially if femoral nerve block is combined with sciatic nerve block and obturator nerve block [8, 18]
All patients received piritramid via a Primary outcome was the pain measured with a numerical rating scale (NRS) from 0 to 10
Summary
Despite total knee arthroplasty (TKA) being considered as one of the most painful surgeries, pain control after surgery is still a challenge and there is currently no generally agreed optimal analgesic regimen after TKA [3, 8, 23]. Continuous peripheral nerve blocks and periarticular local infiltration analgesia (LIA) are commonly used within multimodal pain management concepts. Both techniques have been shown to provide superior analgesia compared to systemic analgesics alone with less opioid consumption and fewer opioid-related side effects like nausea, vomiting and dizziness [10, 21]. Over more than 2 decades continuous peripheral nerve blocks (PNB) have been preferentially applied for TKA offering probably the best postoperative pain control, especially if femoral nerve block is combined with sciatic nerve block and obturator nerve block [8, 18]. Continuous intraarticular analgesia could result in longer pain relief without impairment of muscle function. While some studies demonstrated the efficacy of continuous intraarticular analgesia [4, 5, 13] other studies did not find a relevant effect [2, 9, 14, 22, 24]
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