Local infiltration analgesia adds no clinical benefit in pain control to peripheral nerve blocks after total knee arthroplasty

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Local infiltration analgesia adds no clinical benefit in pain control to peripheral nerve blocks after total knee arthroplasty
Key Take-Away: 

Local infiltration analgesia (LIA) is a simple, surgeon-administered technique where intra-operative administration of local anaesthetic in different combinations with epinephrine, non-steroidal anti-inflammatory drugs, opioids, steroids or all to the wound is employed for the treatment of knee (TKA) arthroplasty. This research shows that the presence of peripheral nerve block leads to the variations in reducing the pain after TKA.

To evaluate the effect of the local infiltration of analgesics for pain after total knee arthroplasty in patients treated with femoral and sciatic peripheral nerve blocks.

ABSTRACT: 
Background: 

To evaluate the effect of the local infiltration of analgesics for pain after total knee arthroplasty in patients treated with femoral and sciatic peripheral nerve blocks.

The secondary objective was to detect differences in analgesic consumption as well as blood loss after local infiltration of analgesics.

Methods: 

Prospective randomized double-blinded study in patients who underwent a TKA for knee osteoarthritis under spinal anesthesia and treated with femoral and sciatic nerve blocks.

This study compared 50 patients treated with local infiltration with ropivacaine, epinephrine, ketorolac and clonidine and 50 patients treated with a placebo with the same technique. The visual analogic score was registered postoperatively at 2, 6, 12, 24, 36, 48 and 72 h after surgery. Analgesic consumption was also registered. Both groups of patients were treated with the same surgical and rehabilitation protocols.

Results: 

A significant difference of one point was found in the visual analogic pain scores 12 h after surgery (0.6 ± 1.5 vs. 1.7 ± 2.3).

There were no significant differences in the visual analogic pain scores evaluated at any other time between 2 and 72 h after surgery. No significant differences were found in the required doses of tramadol or morphine in the postoperative period. Postoperative hemoglobin and blood loss were also similar in both groups.

Conclusion: 

Adding local infiltration of analgesics to peripheral nerve blocks after TKA surgery only provides minimal benefit for pain control. This benefit may be considered as non-clinically relevant.

Moreover, the need for additional analgesics was the same in both groups. Therefore, the use of local infiltration of analgesics treatment in TKA surgery cannot be recommended if peripheral nerve blocks are used.

Knee Surg Sports Traumatol Arthrosc. 2016 Jun 14
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