The ways of pain control after total knee arthroplasty: local infiltration analgesia vs peripheral nerve blocks

Objectives Effective perioperative pain management in total knee arthroplasty (TKA) can significantly reduce the intensity of the pain syndrome, create favorable conditions for the early rehabilitation of the patient, decrease length of hospital stay. To date, various methods of analgesia have been proposed for TKA. On the one hand, this gives the surgical team a wide range of options. On the other hand, this indicates the absence of a single effective method of pain control and emphasizes the relevance of further research and development in this direction. The aim of the study was to evaluate the efficiency and safety of local infiltration analgesia in comparison to a saphenous nerve block and femoral nerve block.

Methods Our prospective, comparative, randomized clinical trial was carried out on 80 patients undergoing TKA. For patients of the first group (20) we used local infiltration analgesia (LIA) of Ropivacaine considering the anatomy of the main neural structures:

n. tibialis, n. peroneus, n. saphenus and r. infrapatellaris n. saphenus. For patients of the second group (20) we used single shot ultrasound-guided saphenous nerve block (SNB). For patients of the third group (20) we used single shot ultrasound-guided femoral nerve block (FNB). For patients of the fourth group (20) we didn’t use LIA, SNB or FNB (control group). The severity of pain, both at rest and during active movements in the knee joint during 24 hours after the operation using VAS, opiod administration and the ability to straight leg raising were assessed. All statistical analyses were performed using “Statistica 10.0”. For randomizing the sealed envelope method was used. In the case of a normal distribution the Student’s t-test was used and the data present as the mean [standard deviation]. The nonparametric data were presented as the mean [confidence interval 95%] and the Mann-Whitney U-test was used for analysis. A statistic significance level of p < 0,05 was taken.

Results and Conclusion There were no difference in severity of pain and administration of opioid analgesics in patients of LIA, SNB, FNB groups (P>0.05). Pain intensity both at rest and during active movements and opioid administration were greater in the control group (P< 0.05). In making an assessment of straight leg raising the best results were obtained in the group of LIA and SNB (P< 0.05). Patients of the FNB group experienced difficulties in performing this test due to the affecting of FNB on motor function and weakening of the quadriceps muscle.

In accordance to our study, the LIA considering the anatomy of the main neural structures demonstrated good pain control results in comparison with peripheral nerve blocks. Moreover, in clinical practice, the LIA is easier to perform than the peripheral nerve blocks, which requires ultrasound device and an experienced specialist.

Stichwörter knee arthroplasty, pain management, infiltration analgesia, nerve block

 

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Publication History

Article published online:
15 October 2020