title: Periarticular injections with continuous perfusion of local anaesthetics provide better pain relief and better function compared to femoral and sciatic blocks after TKA: a randomized clinical trial.
abstract: OBJECTIVE
  Combined femoral and sciatic nerve blocks for post-operative pain management following total knee arthroplasty (TKA) improve patient satisfaction, decrease narcotic consumption and improve pain. However, accompanying motoric weakness can cause falls and related complications. We wonder whether peri-capsular injections in combination with intra-articular perfusion of local anaesthetics would result in equal or less pain without the related complications of nerve blocks. The objective of the study was to verify these aspects in a prospective randomized trial comparing both treatments.
  
  
  METHODS
  Fifty TKA patients randomly received either a femoral (continuous) and a sciatic (single-shot) nerve block (CFNB group, 25 knees) or periarticular infiltrations and a continuous post-operative intra-articular infusion (PIAC group, 25 knees). VAS for pain, pain medication consumption, functional assessment, straight leg raising as well as KSS were recorded post-operatively for 6 days.
  
  
  RESULTS
  VAS (p < 0.001) and KSS (p = 0.05) were significantly better for PIAC. There was increased pain following CFNB compared to PIAC. Catheters stayed for 4 days, a pain 'rebound' occurred after removing in CFNB but not after PIAC. There was no difference in regard to knee function (n.s.), but straight leg raising was significant better following PIAC. There were two falls in patients with CFNB.
  
  
  CONCLUSIONS
  Peri-capsular injections combined with an intra-articular catheter provide better pain control, no rebound pain with better function and might decrease the risk of complications related to motor weakness.
  
  
  METHODS
  I.
authors.affiliation: Department for Endoprosthetics Lower Extremity and Foot Surgery, Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Stathellis
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: W
authors.initials: W
authors.lastname: Fitz
authors.affiliation: St. Vinzenz-Krankenhaus, Düsseldorf, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schnurr
authors.affiliation: MedArtes Praxisklinik, Neutraubling, Germany.
authors.forename: F X
authors.initials: FX
authors.lastname: Koeck
authors.affiliation: HELIOS ENDO-Klinik Hamburg, Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gebauer
authors.affiliation: Department for Endoprosthetics Lower Extremity and Foot Surgery, Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Huth
authors.affiliation: Department for Endoprosthetics Lower Extremity and Foot Surgery, Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Bauer
authors.affiliation: Department for Endoprosthetics Lower Extremity and Foot Surgery, Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany. drjbeckmann@gmx.de.
authors.forename: J
authors.initials: J
authors.lastname: Beckmann
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee; D004334:Drug Administration Schedule; D005260:Female; D005267:Femoral Nerve; D005500:Follow-Up Studies; D006801:Humans; D007263:Infusions, Parenteral; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D012584:Sciatic Nerve; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local
keywords: Infiltration; Intra-articular; LIA; Nerve block; Peri-articular; TKA