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Randomized Controlled Trial
. 2010 Jun;81(3):354-60.
doi: 10.3109/17453674.2010.487241.

Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty

Per Essving  1 , Kjell Axelsson, Jill Kjellberg, Orjan Wallgren, Anil Gupta, Anders Lundin
Affiliations
Randomized Controlled Trial

Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty

Per Essving et al. Acta Orthop. 2010 Jun.

Abstract

Background and purpose: Postoperative pain is often severe after total knee arthroplasty (TKA). We investigated the efficacy of the local infiltration analgesia (LIA) technique, both intraoperatively and postoperatively.

Methods: 48 patients undergoing TKA were randomized into 2 groups in a double-blind study. In group A, 400 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine were infiltrated periarticularly during operation. In group P, no injections were given. 21 h postoperatively, 200 mg ropivacaine, 30 mg ketorolac, and 0.1 mg epinephrine were injected intraarticularly in group A, and the same volume of saline was injected in group P. All patients were followed up for 3 months.

Results: Median morphine consumption was lower in group A during the first 48 h: 18 (1-74) mg vs. 87 (36-160) mg in group P. Postoperative pain was lower at rest in group A during the first 27 h, and on movement during the first 48 h, except at 21 h. Time to fulfillment of discharge criteria was shorter in group A than in group P: 3 (1-7) vs. 5 (2-8) days. Patient satisfaction was higher in group A than in group P on days 1 and 7. The unbound venous blood concentration of ropivacaine was below systemic toxic blood concentrations.

Interpretation: The local infiltration analgesia (LIA) technique provides excellent pain relief and lower morphine consumption following TKA, resulting in shorter time to home readiness and higher patient satisfaction. There were few side effects and systemic LA concentrations were low.

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Figures

Figure 1.
Figure 1.
Flow chart for the study.
Figure 2.
Figure 2.
Postoperative pain at rest. VAS scores are presented as median and interquartile range (IQR). a p < 0.001 (3, 6, and 12 h); p = 0.005 (21 h); p = 0.003 (22 h); p = 0.002 (27 h).
Figure 3.
Figure 3.
Postoperative pain on movement. VAS scores are presented as median and interquartile range (IQR). a p < 0.001 (3, 6, 12, and 22 h); p = 0.005 (27 h); p = 0.01 (48 h).
See this image and copyright information in PMC

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