Comparative study for pain management in total knee replacement: intraoperative tissue infiltration versus peripheral nerve block
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Published:
Jan 22, 2015
Keywords:
Knee replacement, Pain, Analgesia, Peripheral nerve block
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Abstract
Background: The aim of this study is to compare intraoperative infiltration of periarticular soft tissues versus the use of peripheral nerve blocks (sciatic and femoral) for postoperative pain management in total knee arthroplasty.Methods: We prospectively evaluated 60 patients who were divided into two equal groups: group A, with intraoperative infiltration and group B, with femoral and sciatic nerve block before surgery.Results: Pain was significantly lower in group B (block) than in the control group A (infiltration) at 4 and 8 hours after surgery (p = 0.008). Two and three days after surgery, pain curve was inverted and it was statistically lower in group A (p = 0.009 and p = 0.023, respectively).Conclusions: Results showed that both methods were effective in the treatment of pain after surgery and even to reduce opiate use. Low levels of pain and less use of opioids in the immediate postoperative period led to a better rehabilitation and comfort of the patient
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Pesciallo, C., Mana, D., Garabano, G., Lopreite, F., & del Sel, H. (2015). Comparative study for pain management in total knee replacement: intraoperative tissue infiltration versus peripheral nerve block. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 80(1), 12-19. https://doi.org/10.15417/261
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Clinical Research
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References
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through Measurement and Action. Oakbrook Terrace, Illinois, Joint Commission on Accreditation of Healthcare Organizations,
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6. Browne C, Copp S, Reden L, Pulido P, Colwell C Jr. Bupivacaine bolus injection versus placebo for pain management following
total knee arthroplasty. J Arthroplasty 2004;19(3):37.
7. Cook P, Stevens J, Gaudron C. Comparing the effects of femoral nerve block versus femoral and sciatic nerve block on pain
and opiate consumption after total knee arthroplasty. J Artrhoplasty 2003;18(5):583-6.
8. Clarke HD, Scott WN, Insall JN. Anatomía. En: Insall & Scott (eds.) Rodilla, Madrid: Marbán; 2004:13-76.
9. Dahl JB, Anker ME, Spansberg N, Schultz P, Christensen EF. Continuous lumbar plexus block alter arthroplasty. Anesthesia
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postoperative pain. J Artrhoplasty 2004;19(6):720-5.
11. Pesciallo C, Mana Pastrián D, Lopreite L, Astudillo F, del Sel Hernán. Infiltración intraoperatoria para el manejo del dolor en
la artroplastia total de rodilla. Rev Asoc Argent Ortop Traumatol 2009;74:55-62.
12. Weber A, Fourier R, Van Gessel E, Gamulin Z. Sciatic nerve block and the improvement of femoral nerve block analgesia after
total knee replacement. Eur J Anaesthesiol 2002;19:834-8.
13. Dorr LD, Chao L. The emotional state of the patient after total hip and knee arthroplasty. Clin Orthop Relat Res 2007;463:7-12.
14. Wang H, Boctor B, Verner J. The effect of single injection femoral nerve block on rehabilitation and length of hospital stay after
total knee replacement. Reg Anesth Pain Med 2002;27:139-43.
15. Mauerhan DR, Campbell M, Miller JS, Mokris JG, Gregory A, Kiebzak GM. Intraarticular morphine and or bupivacaine in
the management of pain after total knee arthroplasty. J Artrhoplasty 1997;12:547-52.
16. Ritter MA, Koehler M, Keating EM, Faris PM, Meding JB. Intraarticular morphine and or bupivacaine after total knee
replacement. J Bone Joint Surg Br 1999;81:301-3.
17. Lombardi AV, Berend KR, Mallory TH, Dodds KL, Adams JB. Soft tissue and intra-articular injection of bupivacaine,
epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res 2004;(428):125-30.
18. Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, et al. A multimodal analgesia protocol for total
knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 2006;88:282-9.
19. Cousins MJ. Pain: The past, present, and future of anaesthesiology. The E.A. Rovenstine Memorial Lecture. Anesthesiology
1999;91:538-51.
20. Curtiss CP. JCAHO: Meeting the standards for pain management. Orthop Nurs 2001;20:27-30.
21. Hirst GC, Lang SA, Dust WN. Femoral nerve block. Single injection versus continuous infusion for total knee arthroplasty.
Reg Anesth 1996;21:292-6.
22. Hunt K, Bourne MH, Mariani EM. Single-injection femoral and sciatic nerve blocks for pain control after total knee arthroplasty.
J Arthroplasty 2009;24(4):533-8.
23. Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tonnesen EK, Soballe K. Comparison of peri- and intraarticular analgesia
with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop 2007;78(2):159-61.
24. Parker DA, Coolican MRJ, Mather LE, Graham DA, DeWall MJ. Safety of combined of local anesthethic infiltration and
reinfusion drains in total knee arthroplasty. J Arthroplasty 2009;24(6):918-24.
operations. Results of use for analgesia and preemptive blockade. J Bone Joint Surg Am 1996;78:734-8.
2. Barrington MJ, Olive D, Low K, Scott DA, Brittain J, Choong P. Continuous femoral nerve blockade or epidural analgesia
after TKR: a prospective randomized controlled trial. Anesth Analg 2005;101:1824-9.
3. Berry PH, Chapman CR, Covington EC, Dahl JL, Katz JA, Miaskowski C, McLean M (eds.). Pain: Current Understanding
of Assessment, Management and Treatments. Oakbrook Terrace, Illinois, Joint Commission on Accreditation of Healthcare
Organizations, 2001.
4. Berry PH, Dahl JL, Donovan MI, Fine PG, Miaskowski C, Stillman M, et al (eds.). Improving the Quality of Pain Management
through Measurement and Action. Oakbrook Terrace, Illinois, Joint Commission on Accreditation of Healthcare Organizations,
2003.
5. Bonica JJ. Evolution and current status of pain programs. J Pain Symptom Manage 1990;5:368-74.
6. Browne C, Copp S, Reden L, Pulido P, Colwell C Jr. Bupivacaine bolus injection versus placebo for pain management following
total knee arthroplasty. J Arthroplasty 2004;19(3):37.
7. Cook P, Stevens J, Gaudron C. Comparing the effects of femoral nerve block versus femoral and sciatic nerve block on pain
and opiate consumption after total knee arthroplasty. J Artrhoplasty 2003;18(5):583-6.
8. Clarke HD, Scott WN, Insall JN. Anatomía. En: Insall & Scott (eds.) Rodilla, Madrid: Marbán; 2004:13-76.
9. Dahl JB, Anker ME, Spansberg N, Schultz P, Christensen EF. Continuous lumbar plexus block alter arthroplasty. Anesthesia
1988;43(11):989-3.
10. Szczukowski MJ, Hines JA, Snell JA, Sisca TS. Femoral nerve block for total knee arthroplasty patients: a method to control
postoperative pain. J Artrhoplasty 2004;19(6):720-5.
11. Pesciallo C, Mana Pastrián D, Lopreite L, Astudillo F, del Sel Hernán. Infiltración intraoperatoria para el manejo del dolor en
la artroplastia total de rodilla. Rev Asoc Argent Ortop Traumatol 2009;74:55-62.
12. Weber A, Fourier R, Van Gessel E, Gamulin Z. Sciatic nerve block and the improvement of femoral nerve block analgesia after
total knee replacement. Eur J Anaesthesiol 2002;19:834-8.
13. Dorr LD, Chao L. The emotional state of the patient after total hip and knee arthroplasty. Clin Orthop Relat Res 2007;463:7-12.
14. Wang H, Boctor B, Verner J. The effect of single injection femoral nerve block on rehabilitation and length of hospital stay after
total knee replacement. Reg Anesth Pain Med 2002;27:139-43.
15. Mauerhan DR, Campbell M, Miller JS, Mokris JG, Gregory A, Kiebzak GM. Intraarticular morphine and or bupivacaine in
the management of pain after total knee arthroplasty. J Artrhoplasty 1997;12:547-52.
16. Ritter MA, Koehler M, Keating EM, Faris PM, Meding JB. Intraarticular morphine and or bupivacaine after total knee
replacement. J Bone Joint Surg Br 1999;81:301-3.
17. Lombardi AV, Berend KR, Mallory TH, Dodds KL, Adams JB. Soft tissue and intra-articular injection of bupivacaine,
epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res 2004;(428):125-30.
18. Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, et al. A multimodal analgesia protocol for total
knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 2006;88:282-9.
19. Cousins MJ. Pain: The past, present, and future of anaesthesiology. The E.A. Rovenstine Memorial Lecture. Anesthesiology
1999;91:538-51.
20. Curtiss CP. JCAHO: Meeting the standards for pain management. Orthop Nurs 2001;20:27-30.
21. Hirst GC, Lang SA, Dust WN. Femoral nerve block. Single injection versus continuous infusion for total knee arthroplasty.
Reg Anesth 1996;21:292-6.
22. Hunt K, Bourne MH, Mariani EM. Single-injection femoral and sciatic nerve blocks for pain control after total knee arthroplasty.
J Arthroplasty 2009;24(4):533-8.
23. Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tonnesen EK, Soballe K. Comparison of peri- and intraarticular analgesia
with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop 2007;78(2):159-61.
24. Parker DA, Coolican MRJ, Mather LE, Graham DA, DeWall MJ. Safety of combined of local anesthethic infiltration and
reinfusion drains in total knee arthroplasty. J Arthroplasty 2009;24(6):918-24.