J Knee Surg 2022; 35(04): 367-374
DOI: 10.1055/s-0040-1715103
Original Article

Effect of Local Infiltration Analgesia on Functional Outcomes in Total Knee Arthroplasty: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Bayram Unver
1   School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balçova, Izmir, Turkey
,
Ertugrul Yuksel
2   Graduate School of Health Sciences, Dokuz Eylul University, Balçova, Izmir, Turkey
,
Musa Eymir
1   School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balçova, Izmir, Turkey
,
Fikret Maltepe
3   Department of Anesthesiology and Reanimation, School of Medicine, Dokuz Eylul University, Balçova, Izmir, Turkey
,
Vasfi Karatosun
4   Department of Orthopedics and Traumatology, School of Medicine, Dokuz Eylul University, Balçova, Izmir, Turkey
› Author Affiliations
Funding None.

Abstract

Local infiltration analgesia (LIA) is a simple, surgeon-administered technique for the treatment of postoperative pain after total knee arthroplasty (TKA). The aim of the study was to investigate the efficacy of LIA and its effects on functional outcomes in TKA. A total of 135 patients with primary TKA were recruited and randomized either to receive LIA or to receive placebo injection (PI). Pain, active range of motion (ROM), knee function score, functional activities, and hospital length of stay (LOS) were assessed before surgery and from postoperative day (POD) 1 to at discharge. Lower pain scores at rest were recorded on POD1 and POD2 in the LIA group (p = 0.027 and p = 0.020, respectively). Lower pain score on walking was recorded on POD1 in the LIA group (p = 0.002). There was a statistically significant difference in active knee flexion between groups on POD1 (p = 0.038). There was a significant difference in LOS between LIA and PI groups. Shorter stay was seen in LIA group. There were no statistically significant differences between the groups in terms of knee function score and functional outcomes. LIA technique is effective for pain management in the early postoperative period. LIA added benefit for knee function in terms of active knee flexion ROM after TKA. A shorter hospital LOS was observed in LIA group. However, we did not find any differences in groups in terms of functional assessment such as ability to rise from a chair and walking capacity.The level of evidence is randomized controlled trial, level I.



Publication History

Received: 10 October 2020

Accepted: 25 June 2020

Article published online:
24 August 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Carr AJ, Robertsson O, Graves S. et al. Knee replacement. Lancet 2012; 379 (9823): 1331-1340
  • 2 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
  • 3 Tekin B, Unver B, Karatosun V. Expectations in patients with total knee arthroplasty. Acta Orthop Traumatol Turc 2012; 46 (03) 174-180
  • 4 Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am 2011; 93 (11) 1075-1084
  • 5 Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty?. Acta Orthop 2011; 82 (06) 679-684
  • 6 Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 2003; 362 (9399): 1921-1928
  • 7 Essving P, Axelsson K, Åberg E, Spännar H, Gupta A, Lundin A. Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial. Anesth Analg 2011; 113 (04) 926-933
  • 8 Sardana V, Burzynski JM, Scuderi GR. Adductor canal block or local infiltrate analgesia for pain control after total knee arthroplasty? A systematic review and meta-analysis of randomized controlled trials. J Arthroplasty 2019; 34 (01) 183-189
  • 9 Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg 2002; 10 (02) 117-129
  • 10 Borgeat A. The role of regional anesthesia in patient outcome: orthopedic surgery. Tech Reg Anesth Pain Manag 2008; 12 (04) 178-182
  • 11 Carli F, Clemente A, Asenjo JF. et al. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth 2010; 105 (02) 185-195
  • 12 Labraca NS, Castro-Sánchez AM, Matarán-Peñarrocha GA, Arroyo-Morales M, Sánchez-Joya MdelM, Moreno-Lorenzo C. Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: randomized clinical trial. Clin Rehabil 2011; 25 (06) 557-566
  • 13 Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 2008; 79 (02) 174-183
  • 14 Tziona D, Papaioannou M, Mela A, Potamianou S, Makris A. Local infiltration analgesia combined with a standardized multimodal approach including an adductor canal block in total knee arthroplasty: a prospective randomized, placebo-controlled, double-blinded clinical trial. J Anesth 2018; 32 (03) 326-332
  • 15 Williams D, Petruccelli D, Paul J, Piccirillo L, Winemaker M, de Beer J. Continuous infusion of bupivacaine following total knee arthroplasty: a randomized control trial pilot study. J Arthroplasty 2013; 28 (03) 479-484
  • 16 Essving P, Axelsson K, Kjellberg J, Wallgren O, Gupta A, Lundin A. Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty. Acta Orthop 2010; 81 (03) 354-360
  • 17 Goyal N, McKenzie J, Sharkey PF, Parvizi J, Hozack WJ, Austin MS. The 2012 Chitranjan Ranawat award: intraarticular analgesia after TKA reduces pain: a randomized, double-blinded, placebo-controlled, prospective study. Clin Orthop Relat Res 2013; 471 (01) 64-75
  • 18 Joo JH, Park JW, Kim JS, Kim YH. Is intra-articular multimodal drug injection effective in pain management after total knee arthroplasty? A randomized, double-blinded, prospective study. J Arthroplasty 2011; 26 (07) 1095-1099
  • 19 Zhang Z, Shen B. Effectiveness and weakness of local infiltration analgesia in total knee arthroplasty: a systematic review. J Int Med Res 2018; 46 (12) 4874-4884
  • 20 Ikeuchi M, Kamimoto Y, Izumi M. et al. Local infusion analgesia using intra-articular double lumen catheter after total knee arthroplasty: a double blinded randomized control study. Knee Surg Sports Traumatol Arthrosc 2013; 21 (12) 2680-2684
  • 21 Krenzel BA, Cook C, Martin GN, Vail TP, Attarian DE, Bolognesi MP. Posterior capsular injections of ropivacaine during total knee arthroplasty: a randomized, double-blind, placebo-controlled study. J Arthroplasty 2009; 24 (6, Suppl): 138-143
  • 22 Nechleba J, Rogers V, Cortina G, Cooney T. Continuous intra-articular infusion of bupivacaine for postoperative pain following total knee arthroplasty. J Knee Surg 2005; 18 (03) 197-202
  • 23 Dillon JP, Brennan L, Mitchell D. Local infiltration analgesia in hip and knee arthroplasty: an emerging technique. Acta Orthop Belg 2012; 78 (02) 158-163
  • 24 Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. Pain 2011; 152 (10) 2399-2404
  • 25 Unver B, Karatosun V, Bakirhan S. Reliability of goniometric measurements of flexion in total knee arthroplasty patients: with special reference to the body position. J Phys Ther Sci 2009; 21 (03) 257-262 . DOI: 10.1589/jpts.21.257
  • 26 Narin S, Unver B, Bakırhan S, Bozan O, Karatosun V. Cross-cultural adaptation, reliability and validity of the Turkish version of the Hospital for Special Surgery (HSS) knee score. Acta Orthop Traumatol Turc 2014; 48 (03) 241-248
  • 27 Shields RK, Enloe LJ, Evans RE, Smith KB, Steckel SD. Reliability, validity, and responsiveness of functional tests in patients with total joint replacement. Phys Ther 1995; 75 (03) 169-176 , discussion 176–179
  • 28 Yuksel E, Kalkan S, Cekmece S, Unver B, Karatosun V. Assessing minimal detectable changes and test-retest reliability of the timed up and go test and the 2-minute walk test in patients with total knee arthroplasty. J Arthroplasty 2017; 32 (02) 426-430
  • 29 Unver B, Baris RH, Yuksel E, Cekmece S, Kalkan S, Karatosun V. Reliability of 4-meter and 10-meter walk tests after lower extremity surgery. Disabil Rehabil 2017; 39 (25) 2572-2576
  • 30 Browne C, Copp S, Reden L, Pulido P, Colwell Jr C. Bupivacaine bolus injection versus placebo for pain management following total knee arthroplasty. J Arthroplasty 2004; 19 (03) 377-380
  • 31 Berninger MT, Friederichs J, Leidinger W. et al. Effect of local infiltration analgesia, peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in unicompartmental knee arthroplasty. BMC Musculoskelet Disord 2018; 19 (01) 249
  • 32 Busch CA, Shore BJ, Bhandari R. et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 2006; 88 (05) 959-963
  • 33 Fu P, Wu Y, Wu H, Li X, Qian Q, Zhu Y. Efficacy of intra-articular cocktail analgesic injection in total knee arthroplasty - a randomized controlled trial. Knee 2009; 16 (04) 280-284
  • 34 Leownorasate M, Ruangsillapanu N. Post-op pain and blood loss in total knee arthroplasty: an RCT using periarticular injection with diclofenac-based multimodal drugs. J Med Assoc Thai 2014; 97 (12) 1332-1337
  • 35 Niemeläinen M, Kalliovalkama J, Aho AJ, Moilanen T, Eskelinen A. Single periarticular local infiltration analgesia reduces opiate consumption until 48 hours after total knee arthroplasty. A randomized placebo-controlled trial involving 56 patients. Acta Orthop 2014; 85 (06) 614-619
  • 36 Ong JC, Chin PL, Fook-Chong SM, Tang A, Yang KY, Tay BK. Continuous infiltration of local anaesthetic following total knee arthroplasty. J Orthop Surg (Hong Kong) 2010; 18 (02) 203-207
  • 37 Vaishya R, Wani AM, Vijay V. Local infiltration analgesia reduces pain and hospital stay after primary TKA: randomized controlled double blind trial. Acta Orthop Belg 2015; 81 (04) 720-729
  • 38 Vendittoli PA, Makinen P, Drolet P. et al. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 2006; 88 (02) 282-289
  • 39 Zhang S, Wang F, Lu ZD, Li YP, Zhang L, Jin QH. Effect of single-injection versus continuous local infiltration analgesia after total knee arthroplasty: a randomized, double-blind, placebo-controlled study. J Int Med Res 2011; 39 (04) 1369-1380
  • 40 Schilke JM, Johnson GO, Housh TJ, O'Dell JR. Effects of muscle-strength training on the functional status of patients with osteoarthritis of the knee joint. Nurs Res 1996; 45 (02) 68-72
  • 41 Kampitak W, Tanavalee A, Ngarmukos S, Amarase C. Opioid-sparing analgesia and enhanced recovery after total knee arthroplasty using combined triple nerve blocks with local infiltration analgesia. J Arthroplasty 2019; 34 (02) 295-302
  • 42 Terkawi AS, Mavridis D, Sessler DI. et al. Pain management modalities after total knee arthroplasty: a network meta-analysis of 170 randomized controlled trials. Anesthesiology 2017; 126 (05) 923-937
  • 43 Andersen LO, Husted H, Otte KS, Kristensen BB, Kehlet H. High-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand 2008; 52 (10) 1331-1335