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Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty: a randomized double-blind study involving 48 patients
Örebro University, School of Health and Medical Sciences.
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2010 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 81, no 3, p. 354-360Article in journal (Refereed) Published
Abstract [en]

Background and purpose:  Postoperative pain is often severe following total knee arthroplasty (TKA). We investigated the efficacy of local infiltration analgesia (LIA) technique, intra- and postoperatively.

Methods:  48 patients undergoing TKA were randomized into 2 groups in a double-blind study. In group A, 400 mg ropivacaine, 30 mg ketorolac and 0.5 mg epinephrine were infiltrated periarticularly intra-operatively. In group P, no injections were given. At 21 hours postoperatively, 200 mg ropivacaine, 30 mg ketorolac and 0.1 mg epinephrine were injected intraarticularly in group A, and the same volume of saline was injected in group P. Patients were followed up for 3 months.

Results:  Median morphine consumption was lower in group A during 0-48 h: 18 (1-74) mg vs. 87 (36-160) mg in group P. Postoperative pain was lower at rest in group A during the first 27 h, and on movement during the first 48 h, except at 21 h. Time to fulfilling discharge criteria was shorter in group A than in group P; 3 (1-7) vs. 5 (2-8) days. Patient satisfaction was higher in group A compared to group P on day 1 and 7. The unbound venous blood concentration of ropivacaine was below systemic toxic blood concentrations.

 

Interpretation:  Local infiltration analgesia (LIA) technique provides excellent pain relief and lower morphine consumption following TKA, resulting in shorter time to home readiness and higher patient satisfaction. Side effects were few and systemic LA concentrations low.

Place, publisher, year, edition, pages
2010. Vol. 81, no 3, p. 354-360
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-21434DOI: 10.3109/17453674.2010.487241ISI: 000279535900014OAI: oai:DiVA.org:oru-21434DiVA, id: diva2:487463
Available from: 2012-01-31 Created: 2012-01-31 Last updated: 2018-04-11Bibliographically approved
In thesis
1. Local infiltration analgesia in knee arthroplasty
Open this publication in new window or tab >>Local infiltration analgesia in knee arthroplasty
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Local infiltration analgesia (LIA) is a new technique for postoperative pain management following knee arthroplasty. LIA involves a long-acting local anesthetic (ropivacaine), a non-steroid anti-inflammatory drug (ketorolac) and epinephrine infiltrated into the knee joint during surgery and injected postoperatively via a catheter.

In the first two studies, LIA was compared with placebo in unicompartmental (I) and total (II) knee arthroplasty. Postoperative pain levels, morphine consumption and the incidence of side effects were lower in the LIA groups. In addition, we found a shorter length of hospital stay in the LIA group following unicompartmental knee arthroplasty compared with placebo (I), while the time to home readiness was shorter in the LIA group following total knee arthroplasty (II). In this study, we found that the unbound venous blood concentration of ropivacaine was below systemic toxic blood concentrations in a sub-group of patients.

In the third study, LIA was compared with intrathecal morphine for postoperative pain relief following total knee arthroplasty (III). Pain scores and morphine consumption were lower, length of hospital stay was shorter and patient satisfaction was higher in the LIA group.

In the final study, we investigated the effect of minimally invasive surgery (MIS) compared with conventional surgery in unicompartmental knee arthroplasty (IV). Both groups received LIA. We found no statistically significant differences in postoperative pain, morphine consumption, knee function, home readiness, hospital stay or patient satisfaction.

In conclusion, LIA provided better postoperative pain relief and earlier mobilization than placebo, both in unicompartmental and total knee arthroplasty. When compared to intrathecal morphine, LIA also resulted in improved postoperative pain relief and earlier mobilization. Minimally invasive surgery did not improve outcomes after unicompartmental knee arthroplasty, when both groups received LIA.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 61
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 66
Keywords
Knee arthroplasty, minimally invasive surgery, ropivacaine, ketorolac, intrathecal morphine, local infiltration analgesia
National Category
Medical and Health Sciences Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-21412 (URN)978-91-7668-855-7 (ISBN)
Public defence
2012-03-16, Wilandersalen, Örebro universitetssjukhus, Örebro, 09:00 (Swedish)
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Available from: 2012-01-30 Created: 2012-01-30 Last updated: 2017-10-17Bibliographically approved

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