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Pain relieve without impairing muscle function after local infiltration anaesthesia in primary knee arthroplasty: a prospective randomized study

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Purpose of the current study was to compare early effectiveness of pain relieve of 3 in 1 regional pain catheter to local infiltration anesthesia (LIA) in primary total knee arthroplasty (TKA). Secondary endpoint was quadriceps muscle strength after both procedures.

Material and methods

A single-center, prospective, randomized controlled trial was performed. Patients eligible to TKA were either randomized into group 3 in 1 regional pain catheter (C), or group local infiltration anesthesia (L). Pain relieve was assessed by visual analogue scale (VAS) at rest and under physical activity (PA) prior to surgery (t0) and at days one through six. In addition, quadriceps muscle strength ( = straight leg raise) was tested according to the Manual Muscle Testing Scale. Functional outcome was measured using the Oxford Knee Score (OKS) preoperatively and 6 months postoperatively.

Results

121 patients were included in the study. 59 (48.8%) patients were allocated to group C, 62 (51.2%) patients to Group L. No differences concerning pain level evaluated by VAS could be detected between the groups at any time. Comparing straight leg raise test group L was significantly superior over the complete postoperative period (p < 0.03). The mean OKS decreased significantly (p < 0.001) from preoperatively 34.2 ± 7.5 points to 16.9 ± 6.0 points at the six months final follow-up. Regarding OKS there were no intergroup differences at the final follow-up at 6 months postoperative.

Conclusion

There is no significant difference in pain relieve comparing LIA to 3 in 1 catheter in perioperative pain management in TKA. The advantage of LIA is unimpaired quadriceps muscle function in the short-term follow-up.

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Funding and acknowledgements

The study was supported by Dr. Schaedel-Dantscher’s Foundation for medical research. The authors thank for the support.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Freiburg University Hospital, Hugstetterstrasse 55, 79106, Freiburg, Germany

    H. O. Mayr

  2. Department of Knee, Hip and Shoulder Surgery, Schön Clinik Munich-Harlaching, Academic Teaching Hospital of the Paracelsus Private Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria

    H. O. Mayr, W. C. Prall, F. Haasters & Amelie Stoehr

  3. OCM Clinic Munich, Steinerstr. 6, 81369, Munich, Germany

    R. Hube & Amelie Stoehr

  4. Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Nussbaumstr. 20, 80336, Munich, Germany

    W. C. Prall, F. Haasters & S. F. Baumbach

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All authors have participated in the research of the current study.

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Correspondence to Amelie Stoehr.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Mayr, H.O., Prall, W.C., Haasters, F. et al. Pain relieve without impairing muscle function after local infiltration anaesthesia in primary knee arthroplasty: a prospective randomized study. Arch Orthop Trauma Surg 139, 1007–1013 (2019). https://doi.org/10.1007/s00402-019-03194-8

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