title: Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty.
abstract: 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.
authors.affiliation: Department of Orthopedic Surgery, University Hospital, Orebro, Sweden. per.essving@orebroll.se
authors.forename: Per
authors.initials: P
authors.lastname: Essving
authors.forename: Kjell
authors.initials: K
authors.lastname: Axelsson
authors.forename: Jill
authors.initials: J
authors.lastname: Kjellberg
authors.forename: Orjan
authors.initials: O
authors.lastname: Wallgren
authors.forename: Anil
authors.initials: A
authors.lastname: Gupta
authors.forename: Anders
authors.initials: A
authors.lastname: Lundin
mesh_terms: 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
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009020:Morphine; D000077212:Ropivacaine; D020910:Ketorolac
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