title: Pain control after total knee arthroplasty: a prospective study comparing local infiltration anesthesia and epidural anesthesia.
abstract: Postoperative pain control after total knee arthroplasty (TKA) is a well-known clinical problem. Efforts to treat it with the use of local anesthesia have been made, but the results have been contradictive. In the late 1990s, an infiltrated solution of ropivacaine/ketorolac/adrenaline was shown to be effective for this purpose, and this technique has since spread over the world. The purpose of this study was to compare the local infiltration anesthesia technique with epidural anesthesia, which has been the most widely used technique in Sweden.Eighty-five patients received either local infiltration anesthesia or epidural anesthesia for postoperative pain relief. Postoperative morphine consumption, range of motion, walking ability, patient satisfaction, hospital stay, and time in the recovery room were measured. The groups were followed equally. The patients in the local infiltration anesthesia group were mobilized 24 hours earlier. On postoperative day one, 22 of 33 patients in the local infiltration anesthesia group could get in and out of bed without assistance. Only 1 of 31 patients in the epidural anesthesia group could manage this. On postoperative day two, 28 of 33 patients in the local infiltration anesthesia group could walk without assistance, compared to 5 of 31 in the epidural anesthesia group. Seventy-six percent of the local infiltration anesthesia patients were "very satisfied" with their postoperative pain control method, compared to 40% of the epidural anesthesia patients.The local infiltration anesthesia technique is better for postoperative pain relief in TKA than epidural anesthesia. It offers equal pain relief, faster mobilization, and more satisfied patients. No negative side effects were seen during the study.
authors.affiliation: Department of Orthopedics, Capio S:t Görans Hospital, Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Thorsell
authors.forename: Petter
authors.initials: P
authors.lastname: Holst
authors.forename: Hans Christian
authors.initials: HC
authors.lastname: Hyldahl
authors.forename: Lars
authors.initials: L
authors.lastname: Weidenhielm
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D000772:Anesthesia, Local; D018771:Arthralgia / Q000453:epidemiology* / Q000517:prevention & control*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010149:Postoperative Pain / Q000453:epidemiology* / Q000517:prevention & control*; D011446:Prospective Studies; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome