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A randomized comparative evaluation of local infiltration analgesia, extended nerve blocks, and conventional analgesia in pain management after total knee arthroplasty
- Source :
- Joint Diseases and Related Surgery
- Publication Year :
- 2021
-
Abstract
- Objectives: The aim of this study was to analyze the postoperative effects of extended nerve blocks and local infiltration analgesia (LIA) on postoperative pain control, muscle weakness, and blood loss after total knee arthroplasty (TKA). Patients and methods: Between February 24th 2020 and July 10th 2020, a total of 161 patients (55 males, 106 females; median age: 69.0 years [IQR 63.0-75.0], range, 41 to 81 years) who underwent primary TKA were randomly allocated into three parallel groups according to their concomitant procedure in a double-blind fashion: (i) those to whom nerve blockade was performed after competition of surgery under the duration of spinal anesthesia (n=50); (ii) those to whom LIA was performed during surgery (n=52), and (iii) control group (n=59). The content of LIA was 10-10 mL of 20 mg lidocaine with 0.01 mg adrenalin and 100 mg ropivacaine, 1 mL (30 mg) ketorolac, and 5 mL (500 mg) tranexamic acid was diluted by 50 mL 0.9% NaCl under aseptic conditions. Outcome parameters were the evaluation of pain until the evening of first postoperative day (24 to 36 h), mobilization, and blood loss within the first three postoperative days. Results: The pain was maximal between 4 and 8 h postoperatively, when the effect of the spinal anesthetic drugs disappeared. During this critical period, tolerable pain (Numerical Rating Scale, NRS ≤3) was observed in 52%, 42%, and 19% of nerve blockade in LIA and control groups, respectively. None of the patients complained of high-intensity pain (NRS >8) in the LIA group, which was a significant difference from the block and control groups (10% and 14%, p Conclusion: This study demonstrates that LIA technique offers a fast and safe treatment option for pain relief after TKA. No clinically relevant muscle weakness was observed among groups according to field block applications. Significant advantages were also achieved in blood loss.
- Subjects :
- Male
total knee arthroplasty
Lidocaine
medicine.medical_treatment
Walking
nerve block
Hemoglobins
0302 clinical medicine
030202 anesthesiology
Vasoconstrictor Agents
Orthopedics and Sports Medicine
Ropivacaine
Prospective Studies
Anesthetics, Local
Arthroplasty, Replacement, Knee
Aged, 80 and over
030222 orthopedics
Pain, Postoperative
Muscle Weakness
Rehabilitation
Anti-Inflammatory Agents, Non-Steroidal
Middle Aged
Antifibrinolytic Agents
Tranexamic Acid
Anesthesia
Female
Original Article
medicine.symptom
postoperative pain
Tranexamic acid
medicine.drug
Adult
Epinephrine
Local infiltration analgesia
Postoperative Hemorrhage
Anesthesia, Spinal
03 medical and health sciences
Double-Blind Method
medicine
Humans
Pain Management
Aged
business.industry
Muscle weakness
Arthroplasty
Ketorolac
Concomitant
Nerve block
Surgery
Analgesia
business
Anesthesia, Local
Subjects
Details
- ISSN :
- 26874792
- Volume :
- 32
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Joint diseases and related surgery
- Accession number :
- edsair.doi.dedup.....1a978574aba5f64a2aa0791918b31eb0