Abstract
In the recent past, numerous studies evaluating local infiltration analgesia (LIA)
with controversial results have been reported. Efforts have been made to improve patients'
outcome regarding operation techniques and material, as well as pain management and
anesthetic methods. In this study, postoperative pain management and patient satisfaction
were evaluated in patients undergoing total knee replacement surgery with or without
intraoperative LIA. Within the context of the “Quality Improvement in Postoperative
Pain Management” (QUIPS) project, parameters were collected on the first postoperative
day. All patients included in this study underwent primary knee replacement surgery
with general anesthesia. Parameters were compared after performing a 1:1 matched-pair
analysis within 14 orthopaedic departments. Pain levels and pain management satisfaction
were measured using the numerous rating scales, and pain medication use was compared.
From 2010 to 2015, 2,789 patients who underwent primary knee arthroplasty with general
anesthesia were evaluated within the project, of whom a total of 846 patients could
be compared after performing a matched-pair analysis. Pain scores were significantly
better in the LIA group (p = 0.019 for activity pain, p = 0.043 for maximum pain, p < 0.001 for minimum pain), but pain management satisfaction was not superior (p = 0.083). Patients with LIA required less opioids in the recovery room (p = 0.048), while nonopioid medication did not differ significantly (p = 0.603). At the ward, 24 hours postoperatively, no significant difference in the
use for nonopioids (p = 0.789) could be measured, whereas patients in the LIA group received significantly
more opioids (p < 0.001). Although LIA achieved improvement in pain score outcome, and a comparable
patient satisfaction level in the immediate postoperative course, the use of LIA in
knee arthroplasty, controversially discussed in the current literature, was not able
to reduce the need for opioid pain medication in this study.
Keywords
knee arthroplasty - pain management - postoperative pain - local infiltration anesthesia
