title: A comparison of epidural analgesia and local infiltration analgesia methods in pain control following total knee arthroplasty.
abstract: OBJECTIVE
  The aim of this study was to compare the effects of epidural analgesia with infiltration analgesia in postoperative pain control for total knee arthroplasty.
  
  
  METHODS
  Thirty patients (28 female, 2 male; mean age: 69.37±5.11 years, range: 61 to 80 years) undergoing total knee arthroplasty between May 2011 and September 2011 were randomly divided into 2 groups. All patients received spinal anesthesia with bupivacaine. Postoperative analgesia of 72 ml 0.9% NaCl + 48 ml bupivacaine (1 ml = 5 mg, total 120 ml) was administered throughout 24 hours to Group 1 (n=15) by epidural catheter and to Group 2 (n=15) by ON-Q infiltration pump. Groups were compared based on the Bromage scores and visual analog scale (VAS), blood pressure, postoperative analgesia requirement and side effects.
  
  
  RESULTS
  Demographic data were similar in both groups. Rates of additional analgesia requirement at the postoperative 60th minute and 2nd hour were significantly higher in Group 2 than Group 1 (p<0.05). Rates of nausea-vomiting at the postoperative 60th minute and 2nd hour were significantly higher in Group 1 than Group 2 (p<0.05 and p<0.01, respectively). Bromage scores at 60 minutes and 2 hours was significantly higher in Group 1 than in Group 2 (p<0.01). Mean VAS scores at 60 minutes and 2 hours were significantly higher in Group 2 than Group 1 (p<0.05). While a statistically significant difference was found between systolic arterial pressure measurements at 60 minutes (p<0.05), there was no significant difference in diastolic arterial pressure and peak heart rate.
  
  
  CONCLUSIONS
  Although the analgesic effect of local infiltration is provided later than by epidural analgesia, the same level of pain control can be achieved with initial additional analgesia. Local infiltration is superior to epidural analgesia in respect of few side effects and early mobilization.
authors.affiliation: Department of Anesthesiology and Reanimation, Bilecik State Hospital, Bilecik, Turkey. eylem_binici@yahoo.com.
authors.forename: Eylem
authors.initials: E
authors.lastname: Binici Bedir
authors.affiliation: Department of Orthopedics and Traumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey.
authors.forename: Tuhan
authors.initials: T
authors.lastname: Kurtulmuş
authors.affiliation: Department of Anesthesiology and Reanimation, Viranşehir State Hospital, Şanlıurfa, Turkey.
authors.forename: Selma
authors.initials: S
authors.lastname: Başyiğit
authors.affiliation: Department of Orthopedics and Traumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey.
authors.forename: Uğur
authors.initials: U
authors.lastname: Bakır
authors.affiliation: Department of Orthopedics and Traumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey.
authors.forename: Necdet
authors.initials: N
authors.lastname: Sağlam
authors.affiliation: Department of Orthopedics and Traumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey.
authors.forename: Gürsel
authors.initials: G
authors.lastname: Saka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D000772:Anesthesia, Local; D019645:Arthroplasty, Replacement, Knee; D004434:Early Ambulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*