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European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

19.10.2022 | Original Article

Effect of multiple analgesic pathways including local infiltration analgesia, peripheral nerve blocks, and intrathecal morphine for controlling pain after total knee arthroplasty

verfasst von: Siriluk Toolyodpun, Artit Laoruengthana, Inthiporn Kositanurit, Surachart Podjanasupawun, Chao Saenghirunvattana, Krit Pongpirul

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 5/2023

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Abstract

Background

We questioned whether the triple analgesic pathways procedure via local infiltration analgesia (LIA), peripheral nerve blocks, and intrathecal morphine (ITM) is superior to LIA only for controlling pain after Total Knee Arthroplasty (TKA).

Methods

This retrospective study included 192 primary TKA patients. Group A (76 patients) received LIA only, Group B (61 patients) had ITM, adductor canal block and LIA, while Group C (55 patients) received ITM, femoral nerve block and LIA. A propensity score-matched analysis was used to compare visual analog scales (VAS) for pain intensity, total amount of morphine consumption (TMC), angle of knee flexion, and length of hospital stay (LHS).

Results

Group A showed significantly higher VAS than Group B at 12 h (4.27 ± 2.70 vs 2.42 ± 2.35) and 18 h (4.24 ± 2.35 vs 2.18 ± 2.02), and significantly higher than Group C at 6 h (3.46 ± 3.07 vs 0.60 ± 1.50), 12 h (4.27 ± 2.70 vs 0.89 ± 1.48), and 18 h postoperative (4.24 ± 2.35 vs 1.82 ± 2.18). However, the VAS of Group C and B converged to equalize with Group A after 12 and 18 h, respectively. The TMC at 48 h postoperative of Group A was higher than that of Group B (p < 0.01). Nevertheless, there was no difference between groups in terms of knee flexion and LHS, except the LHS of Group B was longer than Group A (p = 0.04).

Conclusion

Triple analgesic pathways could provide a better initial analgesic profile. However, the pain seems to be rebound after resolution of nerve block and ITM, with potentially longer LHS.

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Titel: Effect of multiple analgesic pathways including local infiltration analgesia, peripheral nerve blocks, and intrathecal morphine for controlling pain after total knee arthroplasty
verfasst von: Siriluk Toolyodpun
Artit Laoruengthana
Inthiporn Kositanurit
Surachart Podjanasupawun
Chao Saenghirunvattana
Krit Pongpirul
Publikationsdatum: 19.10.2022
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 5/2023
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-022-03405-w

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