Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty: A randomized double-blind study involving 48 patients

Abstract

Background and purpose Postoperative pain is often severe after total knee arthroplasty (TKA). We investigated the efficacy of the local infiltration analgesia (LIA) technique both intraoperatively and postoperatively. Methods 48 patients undergoing TKA were randomized into 2 groups in a double-blind study. In group A 400 mg ropivacaine 30 mg ketorolac and 0.5 mg epinephrine were infiltrated periarticularly during operation. In group P no injections were given. 21 h postoperatively 200 mg ropivacaine 30 mg ketorolac and 0.1 mg epinephrine were injected intraarticularly in group A and the same volume of saline was injected in group P. All patients were followed up for 3 months. Results Median morphine consumption was lower in group A during the first 48 h: 18 (174) mg vs. 87 (36160) mg in group P. Postoperative pain was lower at rest in group A during the first 27 h and on movement during the first 48 h except at 21 h. Time to fulfillment of discharge criteria was shorter in group A than in group P: 3 (17) vs.5 (28) days. Patient satisfaction was higher in group A than in group P on days 1 and 7. The unbound venous blood concentration of ropivacaine was below systemic toxic blood concentrations. Interpretation The local infiltration analgesia (LIA) technique provides excellent pain relief and lower morphine consumption following TKA resulting in shorter time to home readiness and higher patient satisfaction. There were few side effects and systemic LA concentrations were low. Copyright: © 2010 Nordic Orthopedic Federation.