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Minerva Orthopedics 2022 October;73(5):451-7

DOI: 10.23736/S2784-8469.22.04206-7


language: English

A randomized double-blind study comparing local infiltrative analgesia to standard analgesia for total knee arthroplasty

Sharon ZAMMIT 1 , Karl SPITERI 1, Ian SAID 1 Gaivin BUHAGIAR 2, Stephen SCIBERRAS 2, Joseph N. BORG 1

1 Department of Orthopedics and Trauma, Mater Dei Hospital, Msida, Malta; 2 Department of Anesthesia, Mater Dei Hospital, Msida, Malta

BACKGROUND: With recent trends towards fast-track surgery, regional and local methods of analgesia have enhanced quick recovery. For patients undergoing total knee arthroplasty, the concept of local infiltration analgesia has been introduced with improved outcomes when compared to traditional postoperative pain control methods. In our study we assessed outcome following a regimen of local infiltrative analgesia (LIA): 20 mL of 0.25% bupivacaine with adrenaline (1:100,000), mixed with 10 mg of morphine and 75 mg of diclofenac. This prospective randomized study was designed to assess pain control and morphine consumption following LIA. Secondary aims were the effects of LIA on functional recovery and length of hospital stay.
METHODS: Consecutive patients undergoing elective TKR for primary osteoarthritis were randomized into a study group receiving LIA according to a set protocol and a control group not receiving LIA. Both groups were equipped with patient-controlled analgesia from which morphine consumption was calculated. Pain levels were measured postoperatively.
RESULTS: Improvements in postoperative pain control were demonstrated with use of this LIA technique. There was no significant improvement in morphine consumption, functional recovery and days to discharge.
CONCLUSIONS: This LIA technique using 0.25% bupivacaine with adrenaline, 50 mg diclofenac and 10 mg morphine during total knee replacements provides improved pain control with resultant better patient satisfaction. It has not shown statistically significant functional improvement when compared to standard analgesia alone.

KEY WORDS: Pain, postoperative; Arthroplasty, replacement, knee; Morphine; Analgesia

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