Cargando…

A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty

BACKGROUND: There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural i...

Descripción completa

Detalles Bibliográficos
Autores principales: Andersen, Karen V, Bak, Marie, Christensen, Birgitte V, Harazuk, Jørgen, Pedersen, Niels A, Søballe, Kjeld
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Informa Healthcare 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214751/
https://www.ncbi.nlm.nih.gov/pubmed/20860447
http://dx.doi.org/10.3109/17453674.2010.519165
_version_ 1782216310152757248
author Andersen, Karen V
Bak, Marie
Christensen, Birgitte V
Harazuk, Jørgen
Pedersen, Niels A
Søballe, Kjeld
author_facet Andersen, Karen V
Bak, Marie
Christensen, Birgitte V
Harazuk, Jørgen
Pedersen, Niels A
Søballe, Kjeld
author_sort Andersen, Karen V
collection PubMed
description BACKGROUND: There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion on analgesic requirements and postoperative pain after TKA. METHODS: 40 consecutive patients undergoing elective, primary TKA were randomized into 2 groups to receive either (1) intraoperative wound infiltration with 150 mL ropivacaine (2 mg/mL), 1 mL ketorolac (30 mg/mL), and 0.5 mL epinephrine (1 mg/mL) (total volume 152 mL) combined with intraarticular infusion (4 mL/h) of 190 mL ropivacaine (2 mg/mL) plus 2 mL ketorolac (30 mg/mL) (group A), or (2) epidural infusion (4 mL/h) of 192 mL ropivacaine (2 mg/mL) combined with 6 intravenous administrations of 0.5 mL ketorolac (30 mg/mL) for 48 h postoperatively (group E). For rescue analgesia, intravenous patient-controlled-analgesia (PCA) morphine was used. Morphine consumption, intensity of knee pain (0–100 mm visual analog scale), and side effects were recorded. Length of stay and corrected length of stay were also recorded (the day-patients fulfilled discharge criteria). RESULTS: The median cumulated morphine consumption, pain scores at rest, and pain scores during mobilization were reduced in group A compared to group E. Corrected length of stay was reduced by 25% in group A compared to group E. INTERPRETATION: Peri- and intraarticular analgesia with multimodal drugs provided superior pain relief and reduced morphine consumption compared with continuous epidural infusion with ropivacaine combined with intravenous ketorolac after TKA.
format Online
Article
Text
id pubmed-3214751
institution National Center for Biotechnology Information
language English
publishDate 2010
publisher Informa Healthcare
record_format MEDLINE/PubMed
spelling pubmed-32147512011-11-25 A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty Andersen, Karen V Bak, Marie Christensen, Birgitte V Harazuk, Jørgen Pedersen, Niels A Søballe, Kjeld Acta Orthop Research Article BACKGROUND: There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion on analgesic requirements and postoperative pain after TKA. METHODS: 40 consecutive patients undergoing elective, primary TKA were randomized into 2 groups to receive either (1) intraoperative wound infiltration with 150 mL ropivacaine (2 mg/mL), 1 mL ketorolac (30 mg/mL), and 0.5 mL epinephrine (1 mg/mL) (total volume 152 mL) combined with intraarticular infusion (4 mL/h) of 190 mL ropivacaine (2 mg/mL) plus 2 mL ketorolac (30 mg/mL) (group A), or (2) epidural infusion (4 mL/h) of 192 mL ropivacaine (2 mg/mL) combined with 6 intravenous administrations of 0.5 mL ketorolac (30 mg/mL) for 48 h postoperatively (group E). For rescue analgesia, intravenous patient-controlled-analgesia (PCA) morphine was used. Morphine consumption, intensity of knee pain (0–100 mm visual analog scale), and side effects were recorded. Length of stay and corrected length of stay were also recorded (the day-patients fulfilled discharge criteria). RESULTS: The median cumulated morphine consumption, pain scores at rest, and pain scores during mobilization were reduced in group A compared to group E. Corrected length of stay was reduced by 25% in group A compared to group E. INTERPRETATION: Peri- and intraarticular analgesia with multimodal drugs provided superior pain relief and reduced morphine consumption compared with continuous epidural infusion with ropivacaine combined with intravenous ketorolac after TKA. Informa Healthcare 2010-10 2010-10-08 /pmc/articles/PMC3214751/ /pubmed/20860447 http://dx.doi.org/10.3109/17453674.2010.519165 Text en Copyright: © Nordic Orthopaedic Federation http://creativecommons.org/licenses/by/2.5/ This is an open-access article distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited.
spellingShingle Research Article
Andersen, Karen V
Bak, Marie
Christensen, Birgitte V
Harazuk, Jørgen
Pedersen, Niels A
Søballe, Kjeld
A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty
title A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty
title_full A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty
title_fullStr A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty
title_full_unstemmed A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty
title_short A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty
title_sort randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214751/
https://www.ncbi.nlm.nih.gov/pubmed/20860447
http://dx.doi.org/10.3109/17453674.2010.519165
work_keys_str_mv AT andersenkarenv arandomizedcontrolledtrialcomparinglocalinfiltrationanalgesiawithepiduralinfusionfortotalkneearthroplasty
AT bakmarie arandomizedcontrolledtrialcomparinglocalinfiltrationanalgesiawithepiduralinfusionfortotalkneearthroplasty
AT christensenbirgittev arandomizedcontrolledtrialcomparinglocalinfiltrationanalgesiawithepiduralinfusionfortotalkneearthroplasty
AT harazukjørgen arandomizedcontrolledtrialcomparinglocalinfiltrationanalgesiawithepiduralinfusionfortotalkneearthroplasty
AT pedersennielsa arandomizedcontrolledtrialcomparinglocalinfiltrationanalgesiawithepiduralinfusionfortotalkneearthroplasty
AT søballekjeld arandomizedcontrolledtrialcomparinglocalinfiltrationanalgesiawithepiduralinfusionfortotalkneearthroplasty
AT andersenkarenv randomizedcontrolledtrialcomparinglocalinfiltrationanalgesiawithepiduralinfusionfortotalkneearthroplasty
AT bakmarie randomizedcontrolledtrialcomparinglocalinfiltrationanalgesiawithepiduralinfusionfortotalkneearthroplasty
AT christensenbirgittev randomizedcontrolledtrialcomparinglocalinfiltrationanalgesiawithepiduralinfusionfortotalkneearthroplasty
AT harazukjørgen randomizedcontrolledtrialcomparinglocalinfiltrationanalgesiawithepiduralinfusionfortotalkneearthroplasty
AT pedersennielsa randomizedcontrolledtrialcomparinglocalinfiltrationanalgesiawithepiduralinfusionfortotalkneearthroplasty
AT søballekjeld randomizedcontrolledtrialcomparinglocalinfiltrationanalgesiawithepiduralinfusionfortotalkneearthroplasty