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Local infiltration analgesia provides beneficial
effects in the early postoperative days following TKA, but the risk-benefit
ratio for this technique should also be considered.
The local infiltration analgesia (LIA) emerges as an effective and safe method for controlling pain and functional recovery during total knee arthroplasty (TKA). The evidence for LIA effectiveness was provided by a recent study published in BMC Musculoskeletal Disorders. After total knee arthroplasty, improved muscle strength, mobilization, the range of motion along with postoperative pain management are the crucial necessities to gain early recovery and rehabilitation. The general anaesthesia, spinal anaesthesia, peripheral nerve blocks and LIA are some measures through which the optimal pain management and rapid functional recovery after TKA can be obtained.
M. T. Berninger and colleagues selected a total of 280 patients who went through TKA from Jan 2016 to Aug 2016 for the assessment. These patients were categorized into four classes as per their anaesthetic therapy and related pain. First class was GA&FNB which involved 81 patients who received catheter-based treatments of sciatic and femoral nerve block. The second class was SP&EPI that comprised 51 patients who received an epidural catheter along with spinal or general anaesthesia. The third class was GA&LIA involved 86 patients who went through general anaesthesia along with LIA. The fourth group was SP&LIA involved 61 patients who received spinal anaesthesia with LIA. The pain, muscle strength, range of motion and mobilization up to 7 days were measured as outcomes. The cumulative intake of pain medicine was also evaluated.
All groups exhibited the same pain relief NRS scores, but the group SP&EPI
showed significant lower opioid intake up to 58% as compared to other groups.
Higher muscle strength up to 20% and mobilization up to 26% was noticed in LIA
groups. No complications were seen in any group in the first seven days after
therapies. However, 12.2% of patients from the LIA class and 8.4% patients from
catheter-based class were shifted to other anaesthetic pain medications due to
inadequate pain relief. Despite that, LIA found to be an effective and safe
method for early functional recovery and pain control due to better and higher
muscle strength and mobilization as compared to other groups.
BMC Musculoskelet Disord
Effect of local infiltration analgesia, peripheral nerve blocks, general and spinal anaesthesia on early functional recovery and pain control in total knee arthroplasty
M. T. Berninger et al.
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