Efficacy of Multimodal Peri- and Intraarticular Drug Injections in Total Knee Arthroplasty

Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain, causing patient discomfort, mobilisation and hospital discharge. The aim of this study is to: Compare analgetic efficacy of to types of local infiltration analgesia in total knee arthroplasty. Compare analgetic efficacy of local infiltration analgesia with continuous epidural analgesia.

Total knee arthroplasty (TKA) is increasingly common in the treatment of knee osteoarthritis. TKA is associated with moderate to severe postoperative pain, causing patient discomfort, mobilisation and hospital discharge. Continuous epidural analgesia is often used for controlling pain after TKA. Recent studies describe a new method for pain control after total knee arthroplasty which consists of local infiltration with local anesthetics and adrenaline. This infiltrations can be combined with ketorolac and/or morphine. The aim of this study is to: Compare analgetic efficacy of to types of local infiltration analgesia in total knee arthroplasty. Compare analgetic efficacy of local infiltration analgesia with continuous epidural analgesia.

osteoarthritis, knee arthroplasty, local infiltration analgesia, TKA, epidural analgesia, operation, surgery

Morphine used by patient controlled analgesia. Amount of used morphine during the first 48 hours after surgery were documented in the CRF by the pain nurses.

Each postoperative day, discharge readiness was assessed by an orthopaedic surgeon, a pain nurse, a ward nurse, and a physiotherapist according to the following criteria: no evidence for surgical complications, VAS pain at rest ≤30 mm which is controlled by oral analgesics, ability to eat and drink, ability to walk with elbow crutches, and ability to climb ≥8 stairs.

Inclusion Criteria: patients at least 18 years of age scheduled for elective total knee arthroplasty ASA I-III signed written informed consent Exclusion Criteria: age < 18 ASA > III moderate or severe cardiac disease, bronchial asthma allergy against ropivacaine, ketorolac or morphine analgetic abuse pregnancy or nursing women severe psychiatric disease moderate to severe dementia

Spreng UJ, Dahl V, Hjall A, Fagerland MW, Raeder J. High-volume local infiltration analgesia combined with intravenous or local ketorolac+morphine compared with epidural analgesia after total knee arthroplasty. Br J Anaesth. 2010 Nov;105(5):675-82. doi: 10.1093/bja/aeq232. Epub 2010 Aug 24.