This study explains the positive clinical outcomes of the local infiltration analgesia (LIA) methods by visualization of good infiltration of the majority of nerves supplying the knee. Along with significant pain relief by LIA, use of opioid medication is reduced along with an increase in mobilization and muscle strength. 

To assess the impact of peripheral nerve blocks, local infiltration analgesia (LIA), spinal and general anaesthesia on early functional restoration and pain management in primary total knee arthroplasty.

A total of 280 participants who went through primary TKA were categorised into four groups as per associated pain and anaesthetic procedure. Group GA&FNB comprised femoral and sciatic nerve block with general anaesthesia; Group SP&EPI involved spinal anaesthesia with an epidural catheter; Group GA&LIA and SP&LIA involved LIA combined with general or spinal anaesthesia, respectively. Muscle strength, evaluation of pain, the range of motion, and mobilisation up to 7 days postoperatively were considered as the analysis's outcomes. The cumulative consumption of pain medicine was investigated.

All groups exhibited similar pain relief, but the opioid consumption was considerably lower (up to 58%) in combination with spinal anaesthesia, especially in SP&EPI. In contrast, the LIA groups showed significantly higher muscle strength and mobilisation in the early postoperative period. No surgery-related or analgesic technique-related complications appeared in the first seven days. In total 12.2% of patients in the LIA groups and 8.4% in the catheter-based groups changed the anaesthetics pain management.

The LIA allows a safe and efficient treatment alternative for early functional recovery and pain control in TKA.