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. 2018 Jul 24;19(1):249.
doi: 10.1186/s12891-018-2165-9.

Effect of local infiltration analgesia, peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in unicompartmental knee arthroplasty

M T Berninger  1   2 , J Friederichs  3 , W Leidinger  4 , P Augat  5   6 , V Bühren  3 , C Fulghum  7 , W Reng  7
Affiliations

Effect of local infiltration analgesia, peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in unicompartmental knee arthroplasty

M T Berninger et al. BMC Musculoskelet Disord. .

Abstract

Background: The aim of the study was to analyze the effect of local infiltration analgesia (LIA), peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in primary unicompartmental knee arthroplasty (UKA).

Methods: Between January 2016 until August 2016, 134 patients underwent primary UKA and were subdivided into four groups according to their concomitant pain and anesthetic procedure with catheter-based techniques of femoral and sciatic nerve block (group GA&FNB, n = 38) or epidural catheter (group SP&EPI, n = 20) in combination with general anesthesia or spinal anesthesia, respectively, and LIA combined with general anesthesia (group GA&LIA, n = 46) or spinal anesthesia (group SP&LIA, n = 30). Outcome parameters focused on the evaluation of pain (NRS scores), mobilization, muscle strength and range of motion up to 7 days postoperatively. The cumulative consumption of (rescue) pain medication was analyzed.

Results: The LIA groups revealed significantly lower (about 50%) mean NRS scores (at rest) compared to the catheter-based groups at the day of surgery. In the early postoperative period, the dose of hydromorphone as rescue pain medication was significantly lower (up to 68%) in patients with SP&EPI compared to all other groups. No significant differences could be detected with regard to grade of mobilization, muscle strength and range of motion. However, there seemed to be a trend towards improved mobilization and muscle strength with general anesthesia and LIA, whereof general anesthesia generally tended to ameliorate mobilization.

Conclusions: Except for a significant lower NRS score at rest in the LIA groups at day of surgery, pain relief was comparable in all groups without clinically relevant differences, while the use of opioids was significantly lower in patients with SP&EPI. A clear clinically relevant benefit for LIA in UKA cannot be stated. However, LIA offers a safe and effective treatment option comparable to the well-established conventional procedures.

Keywords: Epidural catheter; Femoral nerve block; General anesthesia; Local infiltration analgesia; Spinal anesthesia; Unicompartmental knee arthroplasty.

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Conflict of interest statement

Ethics approval and consent to participate

This study adhered to the tenets of the Helsinki Declaration and its later amendments. It was conducted according to ICMJE guidelines. Written consent was obtained from all participants for the surgical and anesthetic procedures; further consent for retrospective analysis of the data was waived by the Ethics Committee of the Bavarian State Chamber of Physicians (ID: 2017–109).

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
Numeric Rating Scores at rest (left) and with activity (right) are presented for day of surgery (OP) and postoperative days 1 to 4
Fig. 2
Fig. 2
The cumulative dose of hydromorphone (in mg) for all groups at day of surgery until postoperative days 4 is shown
Fig. 3
Fig. 3
The grade of mobilization (0 to 6) revealed a gradual increase after surgery until postoperative day 7
Fig. 4
Fig. 4
The grade of muscle strength according to the British medical research council (M0/5-M5/5) after surgery until postoperative day 7 is shown
Fig. 5
Fig. 5
Degrees of range of motion (flexion and extension) of all groups from preoperative day to postoperative day 7 are presented
See this image and copyright information in PMC

References

    1. White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee. J Bone Joint Surg Br. 1991;73(4):582–586. doi: 10.1302/0301-620X.73B4.2071640. - DOI - PubMed
    1. Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br. 2011;93(2):198–204. doi: 10.1302/0301-620X.93B2.25767. - DOI - PubMed
    1. Lombardi AV, Jr, Berend KR, Walter CA, Aziz-Jacobo J, Cheney NA. Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty? Clin Orthop Relat Res. 2009;467(6):1450–1457. doi: 10.1007/s11999-009-0731-z. - DOI - PMC - PubMed
    1. Walton NP, Jahromi I, Lewis PL, Dobson PJ, Angel KR, Campbell DG. Patient-perceived outcomes and return to sport and work: TKA versus mini-incision unicompartmental knee arthroplasty. J Knee Surg. 2006;19(2):112–116. doi: 10.1055/s-0030-1248089. - DOI - PubMed
    1. Liddle AD, Judge A, Pandit H, Murray DW. Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet. 2014;384(9952):1437–1445. doi: 10.1016/S0140-6736(14)60419-0. - DOI - PubMed

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