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Randomized Controlled Trial
. 2017 Jul 11;12(1):109.
doi: 10.1186/s13018-017-0616-x.

Local infiltration of analgesia and sciatic nerve block provide similar pain relief after total knee arthroplasty

Hidenori Tanikawa  1 , Kengo Harato  2 , Ryo Ogawa  3 , Tomoyuki Sato  4 , Shu Kobayashi  2 , So Nomoto  5 , Yasuo Niki  2 , Kazunari Okuma  6
Affiliations
Randomized Controlled Trial

Local infiltration of analgesia and sciatic nerve block provide similar pain relief after total knee arthroplasty

Hidenori Tanikawa et al. J Orthop Surg Res. .

Abstract

Background: Although femoral nerve block provides satisfactory analgesia after total knee arthroplasty (TKA), residual posterior knee pain may decrease patient satisfaction. We conducted a randomized controlled trial to clarify the efficacy of the sciatic nerve block (SNB) and local infiltration of analgesia with steroid (LIA) regarding postoperative analgesia after TKA, when administrated in addition to femoral nerve block (FNB).

Methods: Seventy-eight patients were randomly allocated to the two groups: concomitant administration of FNB and SNB or FNB and LIA. The outcome measures included post-operative pain, passive knee motion, C-reactive protein level, time to achieve rehabilitation goals, the Knee Society Score at the time of discharge, patient satisfaction level with anesthesia, length of hospital stay, surgical time, and complications related to local anesthesia.

Results: The patients in group SNB showed less pain than group LIA only on postoperative hours 0 and 3. Satisfactory postoperative analgesia after TKA was also achieved with LIA combined with FNB, while averting the risks associated with SNB. The influence on progress of rehabilitation and length of hospital stay was similar for both anesthesia techniques.

Conclusions: The LIA offers a potentially safer alternative to SNB as an adjunct to FNB, particularly for patients who have risk factors for sciatic nerve injury.

Keywords: Local infiltration of analgesia; Sciatic nerve block; Total knee arthroplasty.

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Conflict of interest statement

Ethics approval and consent to participate

This study followed the Declaration of Helsinki and was approved by the local ethics committee of the Saitama City Hospital, Saitama, Japan.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram in line with CONSORT 2010.* indicates significant differences between LIA and SNB (P < 0.05). LIA local infiltration of analgesia, SNB sciatic nerve block
Fig. 2
Fig. 2
Post-operative pain (numeric rating scale) after total knee arthroplasty. Data are expressed as mean ± SD and are analyzed using the independent Student’s t test. * indicates significant differences between LIA and SNB (P < 0.05). LIA local infiltration of analgesia, SNB sciatic nerve block
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