The Efficacy of Local Infiltration Analgesia for Postoperative Pain Management After Total Knee Arthroplasty

Author(s):  
2021 ◽  
Author(s):  
Rahul Chaturvedi ◽  
Jennifer Tram ◽  
Krishnan Chakravarthy

Total knee arthroplasty (TKA) is a common orthopedic surgery performed with a projected 3.5 million procedures to be done by 2030. Current postoperative pain management for TKA is insufficient, as it results in extensive opioid consumption and functional decline postoperatively. This study identifies the best practices for postoperative TKA pain management through a literature review of the last three years. Studies utilizing interventional techniques (local infiltration analgesia, nerve blocks) and pharmacologic options were reviewed on PubMed, Embase, Ovid Medline and Scopus. Primary outcomes analyzed were the effect of different analgesic approaches on pain reduction, opioid use reduction and improvements in functional mobility or quadriceps strength postoperatively. Additionally, this paper explores the use of cooled radiofrequency ablation, a minimally invasive therapy, for preoperative and postoperative TKA pain management.


Author(s):  
Rodrigo A. Mendoza-Aceves ◽  
Paola G. Gloria-Coronado ◽  
Enrique Ortega Madrid ◽  
Karen Meade Yovanovich ◽  
Mónica Padilla Zavala ◽  
...  

Total knee arthroplasty is commonly performed in patients with end-stage osteoarthritis or rheumatic knee arthritis to relieve joint pain, increase mobility, and improve quality of life. Despite advances in surgical techniques, postoperative pain management in these types of patients is still deficient. An exhaustive review was performed with the available literature, using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2004 to 2021. The search criteria were formulated to identify reports related to total knee replacement and pain management. Pain after total knee arthroplasty has been shown to involve both peripheral and central pain pathways, which is why various postoperative pain management strategies are currently applied, including patient-controlled analgesia, continuous peripheral nerve blocks, or single injection or local infiltration analgesia. Today local techniques such as periarticular injections are becoming more common in total knee replacement due to their effectiveness in controlling pain without causing muscle weakness. The development of minimally invasive techniques associated with multimodal and preventive analgesia improves recovery rates and early rehabilitation in patients undergoing total knee arthroplasty, reducing in-hospital costs, risk of complications, and improving patient satisfaction with chronic osteoarthropathy.  


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