Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Feb 7;4(4):222-227.
doi: 10.11138/jts/2016.4.4.222. eCollection 2016 Oct-Dec.

Pain management in total knee arthroplasty: efficacy of a multimodal opiate-free protocol

Gian Luigi Canata  1 , Valentina Casale  1 , Alfredo Chiey  1
Affiliations

Pain management in total knee arthroplasty: efficacy of a multimodal opiate-free protocol

Gian Luigi Canata et al. Joints. .

Abstract

Purpose: this study was conducted to identify the most effective method of postoperative pain management, comparing the intravenous opiate infusion protocol with the use of a single periarticular local anesthetic infiltration (LAI) in patients undergoing total knee arthroplasty (TKA) surgery.

Methods: 50 patients submitted to TKA surgery between 2013 and 2015 were divided into two groups. Buprenorphine was administered intravenously to the patients in Group A, while the Group B patients received a single periarticular LAI (ropivacaine and ketorolac) during surgery. Pain was assessed using a visual analog scale (VAS) and the knee injury and osteoarthritis outcome score. Hemoglobin and hematocrit were measured in the early postoperative period and at 40 days post-surgery. Range of motion and inflammatory markers were also assessed. Statistical analysis was performed using Student's t-test.

Results: student's t-test showed no significant difference between the groups in functional outcomes or blood values, but a difference in VAS score on the day of surgery was found (p < 0.0001), in favor of Group B.

Conclusions: LAI considerably reduces postoperative pain, allowing rapid mobilization and accelerating functional recovery.

Level of evidence: Level I, prospective single-blind randomized trial.

Keywords: arthroplasty; knee; local anesthetic infiltration; opiate; pain management.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Topical application of tranexamic acid, before starting osteotomies (A) and before deflating the tourniquet and starting the wound closure (B).
Figure 2
Figure 2
Local infiltration analgesia (LAI) of soft tissues with ropivacaine and ketorolac, before implanting the prosthesis.
See this image and copyright information in PMC

References

    1. Fang R, Liu Z, Alijiang A, et al. Efficacy of intra-articular local anesthetics in total knee arthroplasty. Orthopedics. 2015;38:e573–581. - PubMed
    1. Affas F, Nygards EB, Stiller CO, et al. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop. 2011;82:441–447. - PMC - PubMed
    1. Essving P, Axelsson K, Kjellberg J, et al. Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty. Acta Orthop. 2010;81:354–360. - PMC - PubMed
    1. Kurosaka K, Tsukada S, Seino D, et al. Local infiltration analgesia versus continuous femoral nerve block in pain relief after total knee arthroplasty: a randomized controlled trial. J Arthroplasty. 2016;31:913–917. - PubMed
    1. Goyal N, McKenzie J, Sharkey PF, et al. The 2012 Chitranjan Ranawat award: intraarticular analgesia after TKA reduces pain: a randomized, double-blinded, placebo-controlled, prospective study. Clin Orthop Relat Res. 2013;471:64–75. - PMC - PubMed