Wound/intra-articular infiltration or peripheral nerve blocks for orthopedic joint surgery:  efficacy and safety issues.
OBJECTIVE
Pain following arthroplasty is managed utilizing continuous peripheral nerve blocks (PNB) or local infiltration analgesia (LIA). The current economic climate in many countries requires discharge from the hospital within a couple of days following arthroplasty. Earlier studies had documented the efficacy of LIA for lower limb arthroplasty with preserved motor function and early rehabilitation, but some recent studies fail to confirm such a benefit. The motor block associated with PNB can be challenging with well tolerated rehabilitation. This review will discuss the efficacy and safety of these two analgesic techniques.


RESULTS
LIA facilitates early rehabilitation with total knee joint arthroplasty but such a benefit may not be obvious with total hip arthroplasty in the presence of multimodal analgesia. LIA data are very diverse depending on drugs injected, site of catheters, drug dosing and use of adjuvants. Chondrolysis documented with shoulder surgery with LIA is not a concern as there is no cartilage left with arthroplasty except in uniknees. Unpredictable motor weakness poses challenge with lower limb nerve blocks.


CONCLUSIONS
More rigorously conducted large-scale comparative studies are required to document the relative safety and efficacy of these two analgesic techniques. Standardization of infiltration techniques, catheter location, drugs and dosing are much needed. LIA with extended duration long-acting local anesthetic is in its infancy and may be an alternative to PNBs.
Department of Anesthesiology and Perioperative Medicine, Western University, London, Ontario, Canada. sugantha.ganapathy@lhsc.on.ca
Sugantha
S
Ganapathy
D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D001178:Arthroplasty; D006801:Humans; D007270:Injections, Intra-Articular; D007596:Joints / Q000601:surgery*; D035002:Lower Extremity / Q000601:surgery; D009407:Nerve Block / Q000009:adverse effects; D019637:Orthopedic Procedures; D010149:Postoperative Pain / Q000188:drug therapy*; D010525:Peripheral Nerves; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery; D016896:Treatment Outcome; D034941:Upper Extremity / Q000601:surgery; D014947:Wounds and Injuries / Q000517:prevention & control / Q000601:surgery
D000779:Anesthetics, Local