title: Peri-articular injections of local anaesthesia can replace patient-controlled analgesia after total knee arthroplasty: a randomised controlled study.
abstract: OBJECTIVE
  In recent years, there has been an increasing interest in peri-articular injections (PAI) to control post-operative pain after total knee arthroplasty (TKA). Previous studies have evaluated the effect of PAI using multimodal analgaesic protocols, but the concomitant use of patient-controlled analgesia (PCA) may has masked the genuine effects of PAI. We investigated the efficacy of PAI compared with PCA and determined whether conventional PCA can be effectively replaced with PAI after TKA.
  
  
  METHODS
  Eighty patients undergoing unilateral TKA were randomised into two groups. The PCA group consisted of patients who used PCA after surgery, while the PAI group included patients who did not use PCA post-operatively but were given PAI during surgery. We measured changes in visual analogue scale (VAS) scores, straight leg raising (SLR), range of motion (ROM) and consumption of antiemetics or analgaesics.
  
  
  RESULTS
  Pain levels in the PAI group were significantly lower than in the PCA group during two weeks post-operatively (p < 0.05).; functional recovery in the SLR test showed no difference between groups (p > 0.05).; mean ROM showed no difference; (p > 0.05) and there was no difference in the number of patients who needed additional analgaesics. However, antiemetic use was significantly lower for the PAI group (p < 0.05).
  
  
  CONCLUSIONS
  PAI offered improved pain control and minimal side effects compared with PCA. Thus, PAI can replace conventional PCA for controlling post-operative pain after TKA.
authors.affiliation: Department of Orthopaedic Surgery, Daedong General Hospital, Myungryun 1-dong, Dongrae-gu, Busan, 607-711, South Korea. mhsong21@hanmail.net.
authors.forename: Moo-Ho
authors.initials: MH
authors.lastname: Song
authors.affiliation: Department of Orthopaedic Surgery, Daedong General Hospital, Myungryun 1-dong, Dongrae-gu, Busan, 607-711, South Korea. joy46@hanmail.net.
authors.forename: Bu-Hwan
authors.initials: BH
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Daedong General Hospital, Myungryun 1-dong, Dongrae-gu, Busan, 607-711, South Korea. ahnsjosdept@naver.com.
authors.forename: Seong-Jun
authors.initials: SJ
authors.lastname: Ahn
authors.affiliation: Department of Orthopaedic Surgery, Daedong General Hospital, Myungryun 1-dong, Dongrae-gu, Busan, 607-711, South Korea. 70sh-yoo@daum.net.
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Yoo
authors.affiliation: Department of Orthopaedic Surgery, Daedong General Hospital, Myungryun 1-dong, Dongrae-gu, Busan, 607-711, South Korea. redmania-k@daum.net.
authors.forename: Suk-Woong
authors.initials: SW
authors.lastname: Kang
authors.affiliation: Department of Orthopaedic Surgery, Daedong General Hospital, Myungryun 1-dong, Dongrae-gu, Busan, 607-711, South Korea. hovercraft79@daum.net.
authors.forename: Yeong-Joon
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Daedong General Hospital, Myungryun 1-dong, Dongrae-gu, Busan, 607-711, South Korea. kdhbow@daum.net.
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011184:Postoperative Period; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local
keywords: Multimodal analgaesic protocols; Patient-controlled analgesia; Peri-articular injections; TKA