Pain Management in Total Knee Arthroplasty by Intraoperative Local Anesthetic Application and One-shot Femoral Block

Overview

Journal Indian J Orthop

Publisher Springer Nature

Specialty Orthopedics

Date 2017 Jun 2

PMID 28566779

Citations 3

Authors

Aykut Sigirci

Affiliations

Soon will be listed here.

Abstract

Background: Pain after total knee arthroplasty (TKA) is a big problem in orthopaedic surgery. Although opioids and continuous epidural analgesia remain the major options for the postoperative pain management of TKA, they have some undesirable side effects. Epidural analgesia is technically demanding, and the patient requires close monitoring. Different types of local anesthetic applications can successfully treat TKA pain. Local anesthetics have the advantage of minimizing pain at the source. This study investigates the efficacy of different local anesthetic application methods on early, (1 day) pain control after total knee arthroplasty.

Materials And Methods: 200 patients who underwent unilateral TKA surgery under spinal anesthesia were randomly assigned into four different groups (fifty in each group) and were administered pain control by different peri- and postoperative regimens. Group A was the control group wherein no postsurgical analgesia was administered to assess spinal anesthesia efficacy; in Group B, only postsurgical one-shot femoral block was applied; in Group C, intraoperative periarticular local anesthetic was applied; in Group D, a combination of the one-shot femoral block and intraoperative periarticular local anesthetics were applied. Demographic data consisting of age, weight, gender and type of deformity of patients were collected. The data did not differ significantly between the four groups.

Results: Group D patients experienced significantly better postoperative pain relief ( < 0.05) and were therefore more relaxed in pain (painless time, VAS score) and knee flexion (degrees) than the other patient groups in the 1 postoperative day followup. Painless time of Group D was 10.5 hours and was better than Group C (6.8 hours), Group B (6.2 hours) and Group A (3.0 hours) ( < 0.05). Group A got the best pain Vas score degrees in the 1 postoperative day which showed the success of combined periarticülar local anesthetic injection and femoral nerve block.

Conclusion: The intraoperative periarticular application of local anesthetics in addition to one-shot femoral block is an efficient way of controlling postsurgical pain after TKA.

Citing Articles

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Rubin L, Avraham Y, Sharabi-Nov A, Shebly T, Ben Natan M, Rothem D Med Acupunct. 2023; 35(5):230-235.

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Observation and Analysis of the Postoperative Analgesic Effect of Subanaesthetic Dose of Ketamine in Kashin-Beck Disease Patients after Total Knee Arthroplasty.

Xie H, Zhu G, Zhu C, Wang W J Healthc Eng. 2022; 2022:9417594.

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Protective effects of extracellular polymeric substances from on neurotoxicity induced by local anesthetics.

Xue X, Lv Y, Leng Y, Zhang Y Exp Ther Med. 2018; 16(4):3011-3019.

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