title: Pain management in total knee arthroplasty: efficacy of a multimodal opiate-free protocol.
abstract: OBJECTIVE
  this study was conducted to identify the most effective method of postoperative pain management, comparing the intravenous opiate infusion protocol with the use of a single periarticular local anesthetic infiltration (LAI) in patients undergoing total knee arthroplasty (TKA) surgery.
  
  
  METHODS
  50 patients submitted to TKA surgery between 2013 and 2015 were divided into two groups. Buprenorphine was administered intravenously to the patients in Group A, while the Group B patients received a single periarticular LAI (ropivacaine and ketorolac) during surgery. Pain was assessed using a visual analog scale (VAS) and the knee injury and osteoarthritis outcome score. Hemoglobin and hematocrit were measured in the early postoperative period and at 40 days post-surgery. Range of motion and inflammatory markers were also assessed. Statistical analysis was performed using Student's t-test.
  
  
  RESULTS
  student's t-test showed no significant difference between the groups in functional outcomes or blood values, but a difference in VAS score on the day of surgery was found (p < 0.0001), in favor of Group B.
  
  
  CONCLUSIONS
  LAI considerably reduces postoperative pain, allowing rapid mobilization and accelerating functional recovery.
  
  
  METHODS
  Level I, prospective single-blind randomized trial.
authors.affiliation: Centre of Sports Traumatology, Koelliker Hospital, Turin, Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Canata
authors.affiliation: Centre of Sports Traumatology, Koelliker Hospital, Turin, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Casale
authors.affiliation: Centre of Sports Traumatology, Koelliker Hospital, Turin, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Chiey
keywords: arthroplasty; knee; local anesthetic infiltration; opiate; pain management