Summary

Simple and inexpensive method to provide an effective adjunct to a multimodal approach in improving the postoperative course of primary total knee arthroplasty

Abstract

Background

One of the major challenges in total knee arthroplasty (TKA) is optimal pain control. Effective analgesia is the main key in fast-track surgery programs to allow patient's early functional outcomes.
Objectives: To determine short-term pain control, opiod consumption, blood loss and patients' satisfaction at 2,8,12 and 24 hours postsurgery with local infiltration analgesia (LIA) for TKA.
Patients and methods: 150 patients were included in a prospective study between october 2018 and july 2019. TKA were performed by one surgeon. A mini anterior approach was used in all cases. All patients received an intraoperative, intraarticular and softtissue injection (LIA) (20 mL mixture of bupivacain with epinefrin, + levobupicaine 20mL, ketorolac 30 mg + metilprednisolone 40mg and 1gr tranexamic acid). Demographical data and visual analog scale (VAS) score were obtained preoperatively, and postoperative (2,8,12 and 24 hours). Chart review was done to collect data regarding, pain, sedation, rescue narcotic usage, narcotic reversal and blood loss.

Results

In 100% of the cases LIA provided better pain control in the immediate postoperative period, decreases blood loss, decreases the need for rescue narcotics and reversal agents. High level of satisfaction in all cases. No complications were reported.

Conclusions

Soft tissue and intra-articular injection of long-acting local anesthetic provides better pain control in the immediate postoperative period, decreases blood loss, and decreases the need for rescue narcotics and reversal agents. This simple, inexpensive method provides an effective adjunct to a multimodal approach in improving the postoperative course of primary total knee arthroplasty.