Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty.
OBJECTIVE
Postoperative pain is often severe after total knee arthroplasty (TKA). We investigated the efficacy of the local infiltration analgesia (LIA) technique, both intraoperatively and postoperatively.


METHODS
48 patients undergoing TKA were randomized into 2 groups in a double-blind study. In group A, 400 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine were infiltrated periarticularly during operation. In group P, no injections were given. 21 h postoperatively, 200 mg ropivacaine, 30 mg ketorolac, and 0.1 mg epinephrine were injected intraarticularly in group A, and the same volume of saline was injected in group P. All patients were followed up for 3 months.


RESULTS
Median morphine consumption was lower in group A during the first 48 h: 18 (1-74) mg vs. 87 (36-160) mg in group P. Postoperative pain was lower at rest in group A during the first 27 h, and on movement during the first 48 h, except at 21 h. Time to fulfillment of discharge criteria was shorter in group A than in group P: 3 (1-7) vs. 5 (2-8) days. Patient satisfaction was higher in group A than in group P on days 1 and 7. The unbound venous blood concentration of ropivacaine was below systemic toxic blood concentrations.


CONCLUSIONS
The local infiltration analgesia (LIA) technique provides excellent pain relief and lower morphine consumption following TKA, resulting in shorter time to home readiness and higher patient satisfaction. There were few side effects and systemic LA concentrations were low.
Essving
Per
P
Department of Orthopedic Surgery, University Hospital, Orebro, Sweden. per.essving@orebroll.se
Axelsson
Kjell
K
Kjellberg
Jill
J
Wallgren
Orjan
O
Gupta
Anil
A
Lundin
Anders
A
D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007270:Injections, Intra-Articular; D007430:Intraoperative Care; D020910:Ketorolac / Q000008:administration & dosage; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D011182:Postoperative Care; D000077212:Ropivacaine; D016896:Treatment Outcome
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009020:Morphine; D000077212:Ropivacaine; D020910:Ketorolac
Eur J Anaesthesiol. 2000 Jul;17(7):448-55
10964147
J Am Geriatr Soc. 1991 Feb;39(2):142-8
1991946
Acta Orthop. 2009 Apr;80(2):213-9
19404806
Int Orthop. 2004 Oct;28(5):286-9
15480659
Knee. 2005 Oct;12(5):351-7
15994082
Acta Orthop. 2007 Apr;78(2):187-92
17464605
J Bone Joint Surg Am. 2006 May;88(5):959-63
16651569
Br J Anaesth. 1997 May;78(5):507-14
9175963
Acta Orthop. 2007 Apr;78(2):172-9
17464603
Rheumatology (Oxford). 1999 Jul;38(7):663-7
10461482
Acta Anaesthesiol Scand. 2005 Sep;49(8):1191-9
16095462
J Bone Joint Surg Am. 2006 Feb;88(2):282-9
16452738
Acta Orthop. 2007 Apr;78(2):180-6
17464604
Acta Orthop. 2008 Apr;79(2):174-83
18484242
Reg Anesth Pain Med. 2002 Mar-Apr;27(2):139-44
11915059
J Arthroplasty. 2007 Sep;22(6 Suppl 2):33-8
17823012
Arch Orthop Trauma Surg. 2006 Sep;126(7):433-6
16810556
Clin Orthop Relat Res. 2004 Nov;(428):125-30
15534532
Acta Anaesthesiol Scand. 2008 Nov;52(10):1331-5
19025523