Multimodal Periarticular Injection Vs Continuous Femoral Nerve Block After Total Knee Arthroplasty: A Prospective, Crossover, Randomized Clinical Trial

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Abstract

This study compares the efficacy of pain control using continuous femoral nerve block (FNB) and multimodal periarticular soft tissue injection. This is a randomized, crossover, clinical trial. Sixteen patients having bilateral osteoarthritis of the knee scheduled for staged total knee arthroplasty were randomized to receive either FNB (0.2% ropivacaine), via indwelling catheter for 72 hours, or multimodal periarticular soft tissue injection in the first stage. In the second stage, they received the opposite treatment. The primary outcome measure was morphine consumption by patient-controlled analgesia in the first 72 hours postoperatively. Cumulative morphine consumption as well as rest pain and motion pain in the first 72 hours was comparable between the 2 groups. The functional outcomes did not differ significantly. We conclude that multimodal periarticular soft tissue injection provides comparable analgesia to continuous FNB after total knee arthroplasty.

Section snippets

Patients and Methods

This was a prospective, patient- and assessor-blinded, placebo-controlled, crossover randomized clinical trial. This study was approved by the institutional review board. Chinese patients scheduled for staged TKA for osteoarthritis were recruited. The staged operations were performed at a minimum interval of 3 months. Excluded from the study were patients with known allergies to any of the test drugs, those with major systemic illnesses (heart failure, renal impairment, and coagulopathy),

Results

From December 2008 to March 2010, 18 patients (15 females and 3 males) were recruited. One patient, who was randomized to the MPI group in the first-stage operation, refused the second-stage operation because of a spinal problem. Another patient who was randomized to the FNB group in the first-stage operation had a patella fracture 3 months after the operation because of an accidental fall. The results of the remaining 16 patients (14 females and 2 males) were analyzed. Patient demographics and

Discussion

In the last decade, one of the greatest advances in total joint arthroplasty is perioperative pain management [8]. Wound pain after TKA is usually graded as moderate to severe. Patients often fear the postoperative pain more than the risks of the surgery itself. According to the International Association for the Study of Pain, pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” [9]. Pain is

References (22)

  • A.V. Maheshwari et al.

    Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center

    Clin Orthop Relat Res

    (2009)
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    The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.12.021.

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