Tags

Type your tag names separated by a space and hit enter

Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial.
Anesth Analg. 2011 Oct; 113(4):926-33.A&A

Abstract

BACKGROUND

Local infiltration analgesia (LIA)--using a combination of local anesthetics, nonsteroidal anti-inflammatory drugs, and epinephrine, injected periarticularly during surgery-has become popular in postoperative pain management after total knee arthroplasty (TKA). We compared intrathecal morphine with LIA after TKA.

METHODS

In this double-blind study, 50 patients scheduled to undergo TKA under spinal anesthesia were randomized into 2 groups: group M, 0.1 mg morphine was injected intrathecally together with the spinal anesthetic and in group L, LIA using ropivacaine, ketorolac, and epinephrine was infiltrated in the knee during the operation, and 2 bolus injections of the same mixture were given via an intraarticular catheter postoperatively. Postoperative pain, rescue analgesic requirements, mobilization, and home readiness were recorded. Patient-assessed health quality was recorded using the Oxford Knee Score and EQ-5D during 3 months follow-up. The primary endpoint was IV morphine consumption the first 48 postoperative hours.

RESULTS

Mean morphine consumption was significantly lower in group L than in group M during the first 48 postoperative hours: 26 ± 15 vs 54 ± 29 mg, i.e., a mean difference for each 24-hour period of 14.2 (95% confidence interval [CI] 7.6 to 20.9) mg. Pain scores at rest and on movement were lower during the first 48 hours in group L than in group M (P < 0.001). Pain score was also lower when walking in group L than in group M at 24 hours and 48 hours postoperatively (P < 0.001). In group L, more patients were able to climb stairs at 24 hours: 50% (11 of 22) versus 4% (1 of 23), i.e., a difference of 46% (95% CI 23.5 to 68.5) and at 48 hours: 70% (16 of 23) versus 22% (5 of 23), i.e., a difference of 48% (95% CI 23 to 73). Median (range) time to fulfillment of discharge criteria was shorter in group L than in group M, 51 (24-166) hours versus 72 (51-170) hours. The difference was 23 (95% CI 18 to 42) hours (P = 0.001). Length of hospital stay was also shorter in group L than in group M: median (range) 3 (2-17) versus 4 (2-14) days (P = 0.029). Patient satisfaction was greater in group L than in group M (P = 0.001), but no differences were found in knee function, side effects, or in patient-related outcomes, Oxford Knee score, or EQ-5D.

CONCLUSIONS

LIA technique provided better postoperative analgesia and earlier mobilization, resulting in shorter hospital stay, than did intrathecal morphine after TKA.

Authors+Show Affiliations

Department of Orthopedic Surgery, University Hospital, Örebro, Sweden. per.essving@orebroll.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21821506

Citation

Essving, Per, et al. "Local Infiltration Analgesia Versus Intrathecal Morphine for Postoperative Pain Management After Total Knee Arthroplasty: a Randomized Controlled Trial." Anesthesia and Analgesia, vol. 113, no. 4, 2011, pp. 926-33.
Essving P, Axelsson K, Åberg E, et al. Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial. Anesth Analg. 2011;113(4):926-33.
Essving, P., Axelsson, K., Åberg, E., Spännar, H., Gupta, A., & Lundin, A. (2011). Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial. Anesthesia and Analgesia, 113(4), 926-33. https://doi.org/10.1213/ANE.0b013e3182288deb
Essving P, et al. Local Infiltration Analgesia Versus Intrathecal Morphine for Postoperative Pain Management After Total Knee Arthroplasty: a Randomized Controlled Trial. Anesth Analg. 2011;113(4):926-33. PubMed PMID: 21821506.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial. AU - Essving,Per, AU - Axelsson,Kjell, AU - Åberg,Elisabeth, AU - Spännar,Henrik, AU - Gupta,Anil, AU - Lundin,Anders, Y1 - 2011/08/04/ PY - 2011/8/9/entrez PY - 2011/8/9/pubmed PY - 2012/7/17/medline SP - 926 EP - 33 JF - Anesthesia and analgesia JO - Anesth. Analg. VL - 113 IS - 4 N2 - BACKGROUND: Local infiltration analgesia (LIA)--using a combination of local anesthetics, nonsteroidal anti-inflammatory drugs, and epinephrine, injected periarticularly during surgery-has become popular in postoperative pain management after total knee arthroplasty (TKA). We compared intrathecal morphine with LIA after TKA. METHODS: In this double-blind study, 50 patients scheduled to undergo TKA under spinal anesthesia were randomized into 2 groups: group M, 0.1 mg morphine was injected intrathecally together with the spinal anesthetic and in group L, LIA using ropivacaine, ketorolac, and epinephrine was infiltrated in the knee during the operation, and 2 bolus injections of the same mixture were given via an intraarticular catheter postoperatively. Postoperative pain, rescue analgesic requirements, mobilization, and home readiness were recorded. Patient-assessed health quality was recorded using the Oxford Knee Score and EQ-5D during 3 months follow-up. The primary endpoint was IV morphine consumption the first 48 postoperative hours. RESULTS: Mean morphine consumption was significantly lower in group L than in group M during the first 48 postoperative hours: 26 ± 15 vs 54 ± 29 mg, i.e., a mean difference for each 24-hour period of 14.2 (95% confidence interval [CI] 7.6 to 20.9) mg. Pain scores at rest and on movement were lower during the first 48 hours in group L than in group M (P < 0.001). Pain score was also lower when walking in group L than in group M at 24 hours and 48 hours postoperatively (P < 0.001). In group L, more patients were able to climb stairs at 24 hours: 50% (11 of 22) versus 4% (1 of 23), i.e., a difference of 46% (95% CI 23.5 to 68.5) and at 48 hours: 70% (16 of 23) versus 22% (5 of 23), i.e., a difference of 48% (95% CI 23 to 73). Median (range) time to fulfillment of discharge criteria was shorter in group L than in group M, 51 (24-166) hours versus 72 (51-170) hours. The difference was 23 (95% CI 18 to 42) hours (P = 0.001). Length of hospital stay was also shorter in group L than in group M: median (range) 3 (2-17) versus 4 (2-14) days (P = 0.029). Patient satisfaction was greater in group L than in group M (P = 0.001), but no differences were found in knee function, side effects, or in patient-related outcomes, Oxford Knee score, or EQ-5D. CONCLUSIONS: LIA technique provided better postoperative analgesia and earlier mobilization, resulting in shorter hospital stay, than did intrathecal morphine after TKA. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/21821506/Local_infiltration_analgesia_versus_intrathecal_morphine_for_postoperative_pain_management_after_total_knee_arthroplasty:_a_randomized_controlled_trial_ L2 - http://dx.doi.org/10.1213/ANE.0b013e3182288deb DB - PRIME DP - Unbound Medicine ER -