Local Anesthesia Holds Benefits Following Knee Replacement Surgery

Intraarticular delivery of local anesthesia through a catheter may be more beneficial than traditional opioids for managing pain following total knee replacement (TKR) surgery, according to a new study.

Researchers at Thomas Jefferson University Hospital (Philadelphia, PA, USA) conducted a double-blind trial involving 150 primary, unilateral knee replacement patients that were administered either bupivacaine (a common analgesic), or normal saline intraoperatively through a catheter in the joint, which released fluid continually over two postoperative days. The patients were asked to complete questionnaires at 5 PM on the day of surgery and 8 AM and 5 PM each day until discharge, as well as at a four-week follow-up visit.

The initial study results demonstrated that the patients who received bupivacaine had the least pain and the lowest narcotic consumption, with no significant different in postoperative complications and no increase in infection risk. The researchers concluded that intraarticular delivery could provide an effective alternative for pain relief in the immediate postoperative time period without the disadvantages encountered with epidural anesthesia, regional nerve blockade, and patient controlled analgesia pumps. The study was presented at the American Academy of Orthopedic Surgeons (AAOS) annual meeting, held during February 2012 in San Francisco (CA, USA).

“This study opens up a potential new option for better pain management postsurgery for our knee replacement patients. Though further study is needed, these initial results are promising,” said study presenter and coauthor Nitin Goyal, MD.

Postoperative pain control after TKR arthroplasty is a well-known clinical problem. Efforts to treat it with the use of local anesthesia have been made, but the results have been contradictive. In the late 1990s, it was shown that an infiltrated solution of ropivacaine, ketorolac, and adrenaline was effective for this purpose, and this technique has since spread over the world.

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