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ESRA19-0488 Peripheral nerve blocks provide better postoperative pain relief without affecting mobilisation than local infiltration analgesia in enhanced recovery knee arthroplasty
  1. T Bhatti1 and
  2. M Kashif2
  1. 1University Hospitals of Derby and Burton, Anaesthetics, Burton on Trent, UK
  2. 2University Hospitals of Derby and Burton, Anaesthetics, Derby, UK


Background and aims Total knee arthroplasty (TKA) results in moderate to severe postoperative pain. Peripheral nerve blocks (PNB), though very effective, have potential disadvantage of lower limb weakness which affects post op mobilisation after TKA. the present study was carried out to evaluate the analgesic effect of PNB as compared to local infiltration analgesia (LIA) and its impact on postoperative mobilisation after TKA.

Methods In this non-randomised comparative study, 25 patients undergoing ERAS knee arthroplasty received PNB as part of multimodal analgesia for post op analgesia. the results were compared to previously conducted study in which LIA instead of PNB was used as post op analgesia. Rest of the care pathway was similar in both groups. After spinal anaesthesia, patients received ultrasound guided femoral nerve (FNB), adductor canal (ACB) and IPACK nerve blocks using 20 mls Levobupivacaine 0125% for FNB & ACB and 20 mls of Levobupivacaine for IPACK block. Postoperative pain score (0–3), 24 hours opiate consumption and time to mobilisation was recorded and compared with the patients who received LIA only.

Results Average pain score in PNB group was 1 as compared to 2 in LIA group. 3 out of 25 patients (12%) required opioids in first 24 hours after surgery in PNB and 40% in LIA group. There was no difference in postoperative mobilisation in both groups

Conclusions PNB results in superior post op analgesia than LIA after TKA. Appropriate selection of nerve blocks and local anaesthesia concentration does not delay postoperative mobilisation in patients undergoing TKA.

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