Single periarticular local infiltration analgesia reduces opiate consumption until 48 hours after total knee arthroplasty

Abstract

Background — Randomized trials evaluating efficacy of local infiltration analgesia (LIA) have been published but many of these lack standardized analgesics. There is a paucity of reports on the effects of LIA on functional capability and quality of life.

Methods — 56 patients undergoing unilateral total knee arthroplasty (TKA) were randomized into 2 groups in this placebo-controlled study with 12-month follow-up. In the LIA group, a mixture of levobupivacaine (150 mg), ketorolac (30 mg), and adrenaline (0.5 mg) was infiltrated periarticularly. In the placebo group, infiltration contained saline. 4 different patient-reported outcome measures (PROMs) were used for evaluation of functional outcome and quality of life.

Results — During the first 48 hours postoperatively, patients in the LIA group used less oxycodone than patients in the placebo group in both cumulative and time-interval follow-up. The effect was most significant during the first 6 postoperative hours. The PROMs were similar between the groups during the 1-year follow-up.

Interpretation — Single periarticular infiltration reduced the amount of oxycodone used and enabled adequate pain management in conjunction with standardized peroral medication without adverse effects. No clinically marked effects on the functional outcome after TKA were detected.

Design of the protocol: MN, JK, and AE. Enrollment of the patients and surgery: MN, TM, and AE. Anesthetic procedures: JK and AA. Data collection: MN. Data analysis: MN, AE, JK, and AA. All the authors contributed to writing of the manuscript.

We thank Heini Huhtala for statistical advice and research nurse Ella Lehto for assistance with practical issues.

No competing interests declared.