scholarly journals Pain Control after Total Knee Arthroplasty: Comparing Intra-Articular Local Anesthetic Injection with Femoral Nerve Block

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Shengchin Kao ◽  
Hungchen Lee ◽  
Chihwen Cheng ◽  
Chingfeng Lin ◽  
Hsini Tsai
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Pain Control ◽  
Analgesic Efficacy ◽  
Time Interval ◽  
Single Shot ◽  
Total Knee ◽  
High Doses

Background. Direct intra-articular injection of low doses of local anesthetic (IALA) after closure of the joint capsule remains controversial for pain control after total knee arthroplasty (TKA).Methods. A retrospective study comparing patients receiving IALA with high doses (0.5% bupivacaine 60 mL) of local anesthetics or FNB in addition to intravenous patient-controlled analgesia with opioids for pain management after TKA was conducted. The primary end point was to compare the analgesic efficacy and early ambulation between the two groups.Results. No significant differences between the two groups in pain intensity, cumulative opioid consumption, incidences of opioid-related side effects, the time interval from the end of operation to the first time the patient could walk assisted with a walker postoperatively, and postoperative hospital stay were identified. Three patients in the IALA group but none in the FNB group walked within 12 hours after the end of operation.Summary. IALA with high doses of local anesthetics provides comparable analgesic efficacy as single-shot FNB after TKA and might be associated with earlier ambulation than FNB postoperatively.

scholarly journals Comparison of two low dose local anesthetics in combination with morphine for spinal anesthesia for total knee arthroplasty

2020 ◽  
Vol 24 (4) ◽  
Author(s):  
Handan Gulec ◽  
Handan Gulec ◽  
Esra Ozayar ◽  
Asli Alkan ◽  
Merve Kacan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Spinal Anesthesia ◽  
Knee Arthroplasty ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Low Dose ◽  
Total Knee ◽  
High Doses

There is a lack of consensus on the combination doses of local anesthetics and opioids for spinal anesthesia in patients undergoing total knee arthroplasty (TKA) surgery. Opioids and local anesthetic combinations are associated with many postoperative side effects at high doses. We aimed to assess the use of the lowest possible doses of intrathecal bupivacaine and morphine for TKA.

Comparison of Periarticular Infiltration and Combination Delivery of Local Anesthetics for Reducing Pain and Opioid Consumption after Total Knee Arthroplasty

2020 ◽  
Author(s):  
Derek T. Ward ◽  
Eva Grotkopp ◽  
Robert C. Detch ◽  
Hubert T. Kim ◽  
Alfred C. Kuo
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Local Anesthetic ◽  
Combination Treatment ◽  
Local Anesthetics ◽  
Opioid Consumption ◽  
Duration Of Action ◽  
Pain Scores ◽  
Total Knee ◽  
Periarticular Infiltration

AbstractSurgical-site delivery of local anesthetics decreases pain and opioid consumption after total knee arthroplasty (TKA). The optimal route of administration is unknown. We compared local anesthetic delivery using periarticular soft-tissue infiltration to delivery using a combination of preimplantation immersion and intra-articular injection (combination treatment). The records of patients who underwent unilateral, cemented, primary TKA with spinal anesthesia and adductor canal blocks at a single Veterans Affairs Medical Center were retrospectively reviewed. Three subgroups were compared, including controls who did not receive additional local anesthetics, patients who received periarticular infiltration, and patients who received combination treatment. Mean daily pain scores and mean 24-hour opioid consumption on postoperative days (PODs) 0 and 1 were calculated, and analysis of variance was used to assess for significant differences. Factors that were associated with lower pain scores and opioid consumption were then identified using multivariate stepwise regression. There were 26 controls, 25 periarticular infiltration patients, and 39 combination patients. The periarticular infiltration cohort had significantly lower mean pain scores and opioid consumption than controls on POD 0, but not on POD 1. The combination cohort had significantly lower mean pain scores and opioid consumption than controls on PODs 0 and 1. There were no significant differences between the infiltration and combination groups on either day. Multivariate regression analysis showed that infiltration was associated with significantly decreased opioid consumption on both days and decreased pain on POD 0. Combination treatment was associated with significantly decreased pain and opioid consumption on both days. Both local anesthetic periarticular infiltration and combination treatment are associated with decreased pain and opioid consumption after TKA. The stronger effects of the combination treatment compared with periarticular infiltration on POD 1 suggests that combination delivery may have a longer duration of action.

scholarly journals Analgesic Efficacy of the Intra-Articular Administration of High Doses of Morphine in Patients Undergoing Total Knee Arthroplasty

2010 ◽  
Vol 60 (1) ◽  
pp. 1-12 ◽  
Author(s):  
João Batista Santos Garcia ◽  
José Osvaldo Barbosa Neto ◽  
José Wanderley Vasconcelos ◽  
Letácio Santos Garcia Ferro ◽  
Rafaelle Carvalho e Silva
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Analgesic Efficacy ◽  
Total Knee ◽  
High Doses
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