Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: A randomized clinical trial

Abstract

Background Postoperative pain after total knee arthroplasty (TKA) can be difficult to manage and may delay recovery. Recent studies have suggested that periarticular infiltration with local anesthetics may improve outcome.

Methods 80 patients undergoing TKA under spinal anesthesia were randomized to receive continuous femoral nerve block (group F) or peri- and intraarticular infiltration and injection (group I). Group I received a solution of 300 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine by infiltration of the knee at the end of surgery, and 2 postoperative injections of these substances through an intraarticular catheter.

Results More patients in group I than in group F could walk < 3 m on the first postoperative day (29/39 vs. 7/37, p < 0.001). Group I also had significantly lower pain scores during activity and lower consumption of opioids on the first postoperative day. No differences between groups were seen regarding side effects or length of stay.

Interpretation Peri- and intraarticular application of analgesics by infiltration and bolus injections can improve early analgesia and mobilization for patients undergoing TKA. Further studies of optimal drugs, dosage, and duration of this treatment are warranted.

Contributions of authors

All authors made significant contributions to the planning or data collection/interpretation, writing or revision of the manuscript, and approval of the final manuscript. Original idea: ET, KS. Planning and adjustments: KT, LN, FM, VH. Data collection and interpretation: KT, LN, KS. Writing of the manuscript: KT, LN, VH. Revision of manuscript: KT, LN, VH, FM, ET, KS. Approval of final manuscript: KT, LN, VH, FM, ET, KS.

The authors wish to thank Anders Odgaard for his constructive comments on the manuscript. We also wish to thank the nursing staff and physiotherapists involved for the care of study patients and data collection. The study was funded by the Danish Medical Research Council. Equipment and drugs were provided by Aarhus University Hospital.