Postoperative pain control by intra-articular local anesthesia versus femoral nerve block following total knee arthroplasty: impact on discharge.
BACKGROUND
The goal of this retrospective study was to compare pain control following total knee arthroplasty (TKA) on a perioperative protocol of local anesthesia (LA) versus the more classical femoral nerve block (FNB) technique.


OBJECTIVE
Fitness for discharge would be achieved earlier using the LA protocol.


METHODS
Ninety-eight consecutive TKA patients operated on by a single surgeon were included with no selection criteria. In the study group (49 patients), 200 mL ropivacaine 5% was injected into the surgical wound and an intra-articular catheter was fitted to provide continuous infusion of 20 mL/h ropivacaine for 24h. The control group (49 patients) received ropivacaine FNB. Discharge fitness (independent walking, knee flexion>90°, quadricipital control, pain on VAS≤3) and hospital stay were assessed.


RESULTS
Discharge fitness was achieved significantly earlier in the study group (4.2±2.6 versus 6.7±3.2 days; P=0.0003), with significantly shorter mean hospital stay (6.1±3.4 versus 8.8±3.5 days; P=0.0002). The complications rate did not differ between study and control groups.


CONCLUSIONS
Although retrospective, this study indicates that the LA protocol improves management of post-TKA pain and accelerates rehabilitation, thereby, reducing hospital stay. The acceleration effect may be due to the absence of quadriceps inhibition.


METHODS
Level III - Case control study.
Hôpitaux Universitaires de Strasbourg, Service de Chirurgie Orthopédique et Traumatologique, Centre de Chirurgie Orthopédique et de la Main, 10, avenue Bauymann, 67400 Illkirch-Graffenstaden, France.
M
M
Antoni
Hôpitaux Universitaires de Strasbourg, Service de Chirurgie Orthopédique et Traumatologique, Centre de Chirurgie Orthopédique et de la Main, 10, avenue Bauymann, 67400 Illkirch-Graffenstaden, France. Electronic address: jean-yves.jenny@chru-strasbourg.fr.
J-Y
JY
Jenny
Hôpitaux Universitaires de Strasbourg, Service d'Anesthésie-Réanimation, Centre de Chirurgie Orthopédique et de la Main, 10, avenue Bauymann, 67400 Illkirch-Graffenstaden, France.
E
E
Noll
D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint; D007902:Length of Stay / Q000639:trends; D008297:Male; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000628:therapy*; D010351:Patient Discharge / Q000639:trends*; D012189:Retrospective Studies; D000077212:Ropivacaine; D016896:Treatment Outcome
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
Multimodal pain control; Rehabilitation; Total knee arthroplasty