title: The technique of delivery of peri-operative analgesia does not affect the rehabilitation or outcomes following total knee arthroplasty.
abstract: OBJECTIVE
  This non-blinded randomised controlled trial compared the effect of patient-controlled epidural analgesia (PCEA) versus local infiltration analgesia (LIA) within an established enhanced recovery programme on the attainment of discharge criteria and recovery one year after total knee arthroplasty (TKA). The hypothesis was that LIA would increase the proportion of patients discharged from rehabilitation by the fourth post-operative day but would not affect outcomes at one year.
  
  
  METHODS
  A total of 242 patients were randomised; 20 were excluded due to failure of spinal anaesthesia leaving 109 patients in the PCEA group and 113 in the LIA group. Patients were reviewed at six weeks and one year post-operatively.
  
  
  RESULTS
  There was no difference in the proportion of patients discharged from rehabilitation by the fourth post-operative day, (77% in the PCEA group, 82% in the LIA group, p = 0.33), mean length of stay (four days in each group, p = 0.540), day of first mobilisation (p = 0.013) or pain (p = 0.278). There was no difference in mean Oxford Knee Scores (41 points in each group, p = 0.915) or the rate of complications in the two groups.
  
  
  CONCLUSIONS
  Both techniques provided adequate pain relief, enabled early mobilisation and accelerated rehabilitation and good patient-reported outcomes up to one year post-operatively. PCEA and LIA are associated with similar clinical outcomes following TKA. Cite this article: Bone Joint J 2016;98-B1189-96.
authors: Golden Jubilee National Hospital, Agamemnon St, Clydebank G81 4DY, UK.
authors: D A
authors: DA
authors: McDonald
authors: Golden Jubilee National Hospital, Agamemnon St, Clydebank G81 4DY, UK.
authors: A H
authors: AH
authors: Deakin
authors: Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
authors: B M
authors: BM
authors: Ellis
authors: Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
authors: Y
authors: Y
authors: Robb
authors: Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
authors: T E
authors: TE
authors: Howe
authors: Golden Jubilee National Hospital, Agamemnon St, Clydebank G81 4DY, UK.
authors: A W G
authors: AW
authors: Kinninmonth
authors: Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
authors: N B
authors: NB
authors: Scott
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee / Q000379:methods / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods; D010865:Pilot Projects; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local
keywords: Epidural; Local infiltration analgesia; Rehabilitation; Total knee arthroplasty