gms | German Medical Science

Objectives: Total knee replacement (TKA) is accompanied by severe pain syndrome in the early postoperative period. Pain prevents the mobility of the patient, which may increase the frequency of various complications and worsen the functional result. There are various methods to control pain after TKA. The most commonly used ones are femoral and sciatic nerve blocks, local infiltration analgesia and epidural analgesia. However to date, there is no consensus on which of these methods is more effective. The purpose of this study is to evaluate the efficiency and safety of local infiltration analgesia in comparison to a single shot femoral nerve block.

Methods: Our prospective, comparative, randomized clinical trial was carried out on 75 patients undergoing total knee replacement. The surgeries were performed by one surgical team in accordance to a standard technique utilizing a medial arthrotomy and using a pneumatic tourniquet. For patients of the study group (37) we used local infiltration analgesia of Ropivacaine 0.75% 20 ml, Ketorolac 30 mg (1ml), normal saline solution 20 ml. Patients of the control group (38) underwent ultrasound-guided single shot femoral nerve block utilizing Ropivacaine 0.75% 20 ml at the end of the surgery. The pain syndrome was assessed using a visual analog scale for pain at 4, 8 and 24 hours after the operation. Statistica 10.0 software was used for statistical analysis. The nonparametric data were presented as the mean [confidence interval 95%] and the Mann-Whitney U-test was used for analysis. A statistic significance level of p<0.05 was taken.

Results:

The patients of the study group reported significantly less pain (p< 0.05) at 4 and 8 h postoperatively (1.8 [1.4-2.2] and 2.6 [2.2-3]) in comparison to patients from the control group (2.7 [2.2-3.2] and 3.3 [3.1-3.7]). There was no significant difference between the mean pain syndrome in both groups at 24 hours 3.9 [3.6-4.3] and 4.2 [3.9-4.5] (p >0.05). There were no complications associated with the use of these methods of analgesia.

Conclusion:

In accordance to our study, the local infiltration analgesia method demonstrated better pain control results compared to the femoral nerve block. Moreover, this method is more accessible and simple to use.