Local infiltration analgesia versus standard analgesia in total knee arthroplasty

Abstract

Purpose: To compare outcome and cost following local infiltration analgesia (LIA) versus standard analgesia in total knee arthroplasty (TKA).

Methods: 13 men and 33 women (mean age, 67.5 years) underwent TKA by a single surgeon and received LIA (n=24) or standard analgesia (n=22), depending on the availability of the senior anaesthetist.

Results: The 2 groups were comparable at baseline in terms of age, gender, body mass index, American Society of Anesthesiologists score, and range of motion. Compared with the standard analgesia group, the LIA group resulted in a shorter mean length of hospital stay (4.9 vs. 2.7 days, p<0.0001) and higher proportion of patients able to straight leg raise on discharge (38% vs. 86%, p=0.0011), as well as lower pain scores in the first 3 days and greater range of motion at all time points. Respectively in the standard analgesia and LIA groups, the mean cost per patient for all analgesic medication was A$129.25 and A$153.63, the mean cost per patient for all nights spent in hospital was A$1600.36 and A$901.50, and thus the mean total cost per patient was A$1729.61 and A$1055.13.

Conclusion: Compared with standard analgesia, LIA results in greater pain relief and improvement in range of motion immediately after TKA, and lower hospital costs.

Keywords: analgesia; arthroplasty, replacement, knee; length of stay; pain, postoperative.