Advertisement

Additional benefit of local infiltration of analgesia to femoral nerve block in total knee arthroplasty: double-blind randomized control study

  • Koji Aso
  • Masashi Izumi
  • Natsuki Sugimura
  • Yusuke Okanoue
  • Yuko Kamimoto
  • Masataka Yokoyama
  • Masahiko Ikeuchi
KNEE
  • 30 Downloads

Abstract

Purpose

Multimodal analgesia has become an important concept in current pain management following total knee arthroplasty (TKA). However, controversy remains over what is the most accepted combination. In this study, the additional benefits of local infiltration of analgesia to femoral nerve block were evaluated.

Methods

Forty patients were randomly allocated into a combined local infiltration of analgesia and femoral nerve block or femoral nerve block alone group. In the former, analgesic drugs consisting of ropivacaine and dexamethasone were injected into the peri-articular tissues, while the same amount of saline was injected into the femoral nerve block group. The primary outcome measure was the total amount of fentanyl consumption by the patient-controlled analgesia pump during the 48-h post-operative period.

Results

A combination of local infiltration of analgesia and femoral nerve block had less total fentanyl consumption and a larger knee ROM at post-operative day 2 than femoral nerve block alone (p < 0.05). C-reactive protein levels in the combined treatment group were significantly lower than the femoral nerve block group at post-operative day 3 (p < 0.01). There was no difference between the two groups, post-operatively, on the visual analogue scale for pain at rest or while walking, quadriceps strength, timed up and go test, circumference of thigh, Knee Society Score, and Western Ontario and McMaster Universities Osteoarthritis Index.

Conclusion

The addition of local infiltration of analgesia to femoral nerve block promoted post-operative pain relief and the recovery of knee ROM in the early post-operative period. This combination is an effective method for post-operative pain management after TKA.

Level of evidence

Randomized controlled trial, Level I.

Keywords

Total knee arthroplasty Post-operative pain Local infiltration of analgesia Femoral nerve block Randomized controlled trial 

Notes

Acknowledgements

We express our sincere gratitude to all patients who participated in this study.

Author contributions

KA and MI designed the experiments, analyzed and interpreted the results, and wrote the manuscript. KA, NS, MI and MI performed the surgery. YK and MY administered the anaesthesia and post-operative pain management. NS and YO analyzed and interpreted the results. MI directed the study.

Funding

There is no funding source.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest associated with this study.

Ethical approval

All procedures used in this research were approved by the Ethical Review Board of Kochi Medical School (IRB number 24-113).

References

  1. 1.
    Cutolo M, Seriolo B, Pizzorni C, Secchi ME, Soldano S, Paolino S et al (2008) Use of glucocorticoids and risk of infections. Autoimmun Rev 8:153–155CrossRefGoogle Scholar
  2. 2.
    Essving P, Axelsson K, Aberg E, Spannar H, Gupta A, Lundin A (2011) Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial. Anesth Analg 113:926–933CrossRefGoogle Scholar
  3. 3.
    Fowler SJ, Symons J, Sabato S, Myles PS (2008) Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth 100:154–164CrossRefPubMedGoogle Scholar
  4. 4.
    Fu PL, Xiao J, Zhu YL, Wu HS, Li XH, Wu YL et al (2010) Efficacy of a multimodal analgesia protocol in total knee arthroplasty: a randomized, controlled trial. J Int Med Res 38:1404–1412CrossRefGoogle Scholar
  5. 5.
    Hinarejos P, Capurro B, Santiveri X, Ortiz P, Leal J, Pelfort X et al (2016) Local infiltration analgesia adds no clinical benefit in pain control to peripheral nerve blocks after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:3299–3305CrossRefPubMedGoogle Scholar
  6. 6.
    Holte K, Kehlet H (2002) Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg 195:694–712CrossRefPubMedGoogle Scholar
  7. 7.
    Hu B, Lin T, Yan SG, Tong SL, Yu JH, Xu JJ et al (2016) Local infiltration analgesia versus regional blockade for postoperative analgesia in total knee arthroplasty: a meta-analysis of randomized controlled trials. Pain Phys 19:205–214Google Scholar
  8. 8.
    Ikeuchi M, Kamimoto Y, Izumi M, Fukunaga K, Aso K, Sugimura N et al (2014) Effects of dexamethasone on local infiltration analgesia in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 22:1638–1643CrossRefPubMedGoogle Scholar
  9. 9.
    Keijsers R, van Delft R, van den Bekerom MP, de Vries DC, Brohet RM, Nolte PA (2015) Local infiltration analgesia following total knee arthroplasty: effect on post-operative pain and opioid consumption—a meta-analysis. Knee Surg Sports Traumatol Arthrosc 23:1956–1963CrossRefPubMedGoogle Scholar
  10. 10.
    Li C, Qu J, Pan S, Qu Y (2018) Local infiltration anesthesia versus epidural analgesia for postoperative pain control in total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 13:112CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Maheshwari AV, Blum YC, Shekhar L, Ranawat AS, Ranawat CS (2009) Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res 467:1418–1423CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Narum S, Westergren T, Klemp M (2014) Corticosteroids and risk of gastrointestinal bleeding: a systematic review and meta-analysis. BMJ Open 4:e004587CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Osawa A, Yoshida K, Kanazawa H, Maruyama Y, Kaneko K (2014) Efficacy of periarticular multimodal drug injection in total knee arthroplasty for pain management and rehabilitation. Osteoarthr Cartil 22:S415–S416CrossRefGoogle Scholar
  14. 14.
    Park JH, Restrepo C, Norton R, Mandel S, Sharkey PF, Parvizi J (2013) Common peroneal nerve palsy following total knee arthroplasty: prognostic factors and course of recovery. J Arthroplasty 28:1538–1542CrossRefPubMedGoogle Scholar
  15. 15.
    Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A et al (2010) Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology 113:1144–1162CrossRefPubMedGoogle Scholar
  16. 16.
    Ranawat AS, Ranawat CS (2007) Pain management and accelerated rehabilitation for total hip and total knee arthroplasty. J Arthroplasty 22:12–15CrossRefPubMedGoogle Scholar
  17. 17.
    Schinsky MF, Macaulay W, Parks ML, Kiernan H, Nercessian OA (2001) Nerve injury after primary total knee arthroplasty. J Arthroplasty 16:1048–1054CrossRefPubMedGoogle Scholar
  18. 18.
    Seangleulur A, Vanasbodeekul P, Prapaitrakool S, Worathongchai S, Anothaisintawee T, McEvoy M et al (2016) The efficacy of local infiltration analgesia in the early postoperative period after total knee arthroplasty: a systematic review and meta-analysis. Eur J Anaesthesiol 33:816–831CrossRefPubMedGoogle Scholar
  19. 19.
    Spreng UJ, Dahl V, Hjall A, Fagerland MW, Raeder J (2010) High-volume local infiltration analgesia combined with intravenous or local ketorolac + morphine compared with epidural analgesia after total knee arthroplasty. Br J Anaesth 105:675–682CrossRefPubMedGoogle Scholar
  20. 20.
    Tanikawa H, Harato K, Ogawa R, Sato T, Kobayashi S, Nomoto S et al (2017) Local infiltration of analgesia and sciatic nerve block provide similar pain relief after total knee arthroplasty. J Orthop Surg Res 12:109CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Tanikawa H, Sato T, Nagafuchi M, Takeda K, Oshida J, Okuma K (2014) Comparison of local infiltration of analgesia and sciatic nerve block in addition to femoral nerve block for total knee arthroplasty. J Arthroplasty 29:2462–2467CrossRefPubMedGoogle Scholar
  22. 22.
    Thorsell M, Holst P, Hyldahl HC, Weidenhielm L (2010) Pain control after total knee arthroplasty: a prospective study comparing local infiltration anesthesia and epidural anesthesia. Orthopedics 33:75–80CrossRefPubMedGoogle Scholar
  23. 23.
    Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tonnesen EK, Soballe K (2007) Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop 78:172–179CrossRefPubMedGoogle Scholar
  24. 24.
    Wang AS, Armstrong EJ, Armstrong AW (2013) Corticosteroids and wound healing: clinical considerations in the perioperative period. Am J Surg 206:410–417CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Kochi Medical SchoolKochi UniversityNankokuJapan
  2. 2.Department of Anaesthesiology, Kochi Medical School, Japan Kochi Medical SchoolKochi UniversityNankokuJapan

Personalised recommendations