Top

International Orthopaedics

Published in:

01-01-2017 | Original Paper

Effects of multi-site infiltration analgesia on pain management and early rehabilitation compared with femoral nerve or adductor canal block for patients undergoing total knee arthroplasty: a prospective randomized controlled trial

Authors: Donghai Li, Zhen Tan, Pengde Kang, Bin Shen, Fuxing Pei

Published in: International Orthopaedics | Issue 1/2017

Abstract

Purpose

The aim of this study was to combine intra-articular and peri-articular with wound infiltration analgesia (multi-site infiltration analgesia, MIA) for patients undergoing total knee arthroplasty (TKA) and compare its pain management and early rehabilitation effect with the commonly used nerve block including adductor cannel block (FNB) and femoral nerve block (ACB).

Method

We conducted a prospective randomized controlled trial and 77 patients were included for analysis. The patients were randomized over three groups. The first group (26 patients) received multi-site infiltration analgesia (MIA group), the second group (27 patients) received femoral nerve block (FNB group), and the third group (24 patients) received adductor cannel block (ACB group).

Results

MIA showed better pain control at rest during the first 12 hours (p < 0.05 respectively) and less opioid consumption after operation than the other two groups (p < 0.05, respectively), but ACB and FNB revealed similar outcomes (p > 0.05). At the same time, there are no significant differences in pain score with activity, vital signs, and occurrence of complication (p > 0.05, respectively) among the three groups. When evaluated the early rehabilitation, MIA and ACB had similar outcomes on post-operative muscle strength (p > 0.05), but they showed better quadriceps strength when compared FNB (p < 0.05). Although the knee ROM of the patients with FNB showed better results (p < 0.05), their ambulation ability was inferior to those in MIA group (p < 0.05 and ACB group (p < 0.05) early after the operation, besides, MIA patients were superior to ACB patients (p < 0.05). Furthermore, MIA spent less time on operation and post-operative hospital stays when compared with FNB and ACB (p < 0.05, respectively), while the ACB and FNB were without significant difference (p < 0.05, respectively).

Conclusion

ACB was not inferior to FNB on pain control, but it was better on early mobilization. However, MIA that combine intra-articular and peri-articular with wound infiltration analgesia after TKA was more effective on pain control at rest, with better efficacy on early rehabilitation and easier to perform when compared with these commonly used nerve block. We recommended our MIA for pain relief and fast rehabilitation after TKA.

Parvizi J, Miller AG, Gandhi K (2011) Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am 93(11):1075–1084CrossRefPubMed

Husted H, Lunn TH, Troelsen A et al (2011) Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop 82(6):679–684CrossRefPubMedPubMedCentral

Korean Knee Society (2012) Guidelines for the management of postoperative pain after total knee arthroplasty. Knee Surg Relat Res 24(4):201–207CrossRefPubMedCentral

Fischer HB, Simanski CJ, Sharp C et al (2008) PROSPECT Working Group. a procedure specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia 63:1105CrossRefPubMed

Kurosaka K, Tsukada S, Seino D, Morooka T, Nakayama H, Yoshiya S (2016) Local infiltration analgesia versus continuous femoral nerve block in pain relief after total knee arthroplasty: a randomized controlled trial. J Arthroplasty 31(4):913–917CrossRefPubMed

Soltesz S, Meiger D, Milles-Thieme S, Saxler G, Ziegeler S (2016) Intermittent versus continuous sciatic block combined with femoral block for patients undergoing knee arthroplasty. a randomized controlled trial. Int Orthop. doi:10.1007/s00264-016-3117-3 PubMed

Paul JE, Arya A, Hurlburt L, Cheng J (2010) Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a metaanalysis of randomized controlled trials. Anesthesiology 113:1144–1162CrossRefPubMed

Hadzic A, Houle TT, Capdevila X, Ilfeld BM (2010) Femoral nerve block for analgesia in patients having knee arthroplasty. Anesthesiology 113:1014–1015CrossRefPubMed

Tanikawa H, Sato T, Nagafuchi M et al (2014) Comparison of local infiltration of analgesia and sciatic nerve block in addition to femoral nerve block for total knee arthroplasty. J Arthroplasty 29:2462–2467CrossRefPubMed

10.

Albrecht E, Morfey D, Chan V et al (2014) Single-injection or continuous femoral nerve block for total knee arthroplasty? Clin Orthop Relat R 472:1384–1393CrossRef

11.

Sakai N, Inoue T, Kunugiza Y et al (2013) Continuous femoral versus epidural block for attainment of 120° knee flexion after total knee arthroplasty: a randomized controlled trial. J Arthroplasty 28:807–814CrossRefPubMed

12.

Pelt CE, Anderson AW, Anderson MB et al (2014) Postoperative falls after total knee arthroplasty in patients with a femoral nerve catheter: can we reduce the incidence? J Arthroplasty 29:1154–1157CrossRefPubMed

13.

Sharma S, Iorio R, Specht LM et al (2010) Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res 468:135–140CrossRefPubMed

14.

Wasserstein D, Farlinger C, Brull R et al (2013) Advanced age, obesity and continuous femoral nerve blockade are independent risk factors for inpatient falls after primary total knee arthroplasty. J Arthroplasty 28:1121–1124CrossRefPubMed

15.

Elkassabany NM, Antosh S, Ahmed M et al (2016) The risk of falls after total knee arthroplasty with the use of a femoral nerve block versus an adductor canal block: a double-blinded randomized controlled study. Anesth Analg 122:1696–1703CrossRefPubMed

16.

Andersen HL, Zaric D (2014) Adductor canal block or midthigh saphenous nerve block same but different name! Reg Anesth Pain Med 39:256–257CrossRefPubMed

17.

Jin SQ, Ding XB, Tong Y (2015) Effect of saphenous nerve block for post-operative pain on knee surgery: a meta-analysis. Int J Clin Exp Med 8:368–376PubMedPubMedCentral

18.

Hanson NA, Allen CJ, Hostetter LS, Nagy R (2014) Continuous ultrasound-guided adductor canal block for total knee arthroplasty: a randomized, double-blind trial. Anesth Analg 118:1370–1377CrossRefPubMed

19.

Li D, Yang Z, Xie X, Zhao J, Kang P (2016) Adductor canal block provides better performance after total knee arthroplasty compared with femoral nerve block: a systematic review and meta-analysis. Int Orthop 40:925–933CrossRefPubMed

20.

Song MH, Kim BH, Ahn SJ, Yoo SH, Kang SW, Kim YJ, Kim DH (2016) (2016) Peri-articular injections of local anaesthesia can replace patient-controlled analgesia after total knee arthroplasty: a randomised controlled study. Int Orthop 40(2):295–299. doi:10.1007/s00264-015-2940-2 CrossRefPubMed

21.

Manickam B, Perlas A, Duggan E et al (2009) Feasibility and efficacy of ultrasound-guided block of the saphenous nerve in the adductor canal. Reg Anesth Pain Med 34:578–580CrossRefPubMed

22.

Akkaya T, Ersan O, Ozkan D et al (2008) Saphenous nerve block is an effective regional technique for post-menisectomy pain. Knee Surg Sports Traumatol Arthrosc 16:855–858CrossRefPubMed

23.

Mudumbai SC, Kim TE, Howard SK et al (2014) Continuous adductor canal blocks are superior to continuous femoral nerve blocks in promoting early ambulation after TKA. Clin Orthop Relat Res 472:1377–1383CrossRefPubMed

24.

Jenstrup MT, Jæger P, Lund J et al (2012) Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand 56:357–364CrossRefPubMed

25.

Jæger P, Zaric D, Fomsgaard JS et al (2013) Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med 38:526–532CrossRefPubMed

26.

Saranteas T, Anagnositis G, Paraskeuopoulos T, Koulalis D, Kokkalis Z, Nakou M, Anagnostopoulou S, Kostopanagiotou G (2011) Anatomy and clinical implications of the ultrasound-guided subsartorial saphenous nerve block. Reg Anesth Pain Med 36:399–402CrossRefPubMed

27.

Gibbs DM, Green TP, Esler CN (2012) The local infiltration of analgesia following total knee replacement. a review of current literature. J Bone Joint Surg (Br) 94:1154–1159CrossRef

28.

Nagafuchi M, Sato T, Sakuma T (2015) Femoral nerve block-sciatic nerve block vs. femoral nerve block-local infiltration analgesia for total knee arthroplasty: a randomized controlled trial. BMC Anesthesiol 15:182CrossRefPubMedPubMedCentral

29.

Krych AJ, Pagnano MW (2015) Review: femoral nerve block may be the most effective option for pain relief following total knee replacement. Evid Based Nurs 18:57CrossRefPubMed

30.

Albrecht E, Guyen O, Jacot-Guillarmod A et al (2016) The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 116:597–609CrossRefPubMed

31.

Fan L, Yu X, Zan P, Liu J, Ji T, Li G (2016) Comparison of local infiltration analgesia with femoral nerve block for total knee arthroplasty: a prospective, randomized clinical trial. J Arthroplasty 31:1361–1365CrossRefPubMed

32.

Yun XD, Yin XL, Jiang J et al (2015) Local infiltration analgesia versus femoral nerve block in total knee arthroplasty: a meta-analysis. Orthop Traumatol Surg Res 101:565–569CrossRefPubMed

33.

Ali A, Sundberg M, Hansson U et al (2015) Doubtful effect of continuous intraarticular analgesia after total knee arthroplasty: a randomized double-blind study of 200 patients. Acta Orthop 86:373–377CrossRefPubMedPubMedCentral

34.

Guo D, Cao XW, Liu JW et al (2014) Continuous intra-articular infusion anesthesia for pain control after total knee arthroplasty: study protocol for a randomized controlled trial. Trials 15:245CrossRefPubMedPubMedCentral

35.

Kovalak E, Doğan AT, Üzümcügil O et al (2015) A comparison of continuous femoral nerve block and periarticular local infiltration analgesia in the management of early period pain developing after total knee arthroplasty. Acta Orthop Traumatol Turc 49:260–266PubMed

36.

Sawhney M, Mehdian H, Kashin B (2016) Pain after unilateral total knee arthroplasty: a prospective randomized controlled trial examining the analgesic effectiveness of a combined adductor canal peripheral nerve block with periarticular infiltration versus adductor canal nerve block alone versus periarticular infiltration alone. Anesth Analg 122:2040–2046CrossRefPubMed

37.

Emerson RH Jr, Barrington JW, Olugbode O et al (2016) Femoral nerve block versus long-acting wound infiltration in total knee arthroplasty. Orthopedics 17:1–7

38.

Marques EM, Blom AW, Lenguerrand E et al (2015) Local anaesthetic wound infiltration in addition to standard anaesthetic regimen in total hip and knee replacement: long-term cost-effectiveness analyses alongside the APEX randomised controlled trials. BMC Med 13:151CrossRefPubMedPubMedCentral

39.

Ilfeld BM, Duke KB, Donohue MC (2010) The association between lower extremity continuous peripheral nerve block and patient fall after knee and hip arthroplasty. Anesth Analg 111:1552–1554CrossRefPubMedPubMedCentral

40.

Sapega AA (1990) Muscle performance evaluation in orthopaedic practice. J Bone Joint Surg Am 72:1562–1574CrossRefPubMed

41.

Yeung TS, Wessel J, Stratford PW, MacDermid JC (2008) The Timed Up and Go test for use on an inpatient orthopaedic rehabilitation ward. J Orthop Sports Phys Ther 38:410–417CrossRefPubMed

42.

Memtsoudis SG, Yoo D, Stundner O et al (2015) Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement. Int Orthop 39:673–680CrossRefPubMed

43.

Mei S, Jin S, Chen Z, Ding X, Zhao X, Li Q (2015) Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block. Clinics (Sao Paulo) 70:648–653CrossRef

44.

Affas F, Nygårds EB, Stiller CO, Wretenberg P, Olofsson C (2011) Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop 82:441–447CrossRefPubMedPubMedCentral

45.

Carli F, Clemente A, Asenjo JF et al (2010) Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth 105:185–195CrossRefPubMed

46.

Ashraf A, Raut VV, Canty SJ et al (2013) Pain control after primary total knee replacement. a prospective controlled trial of local infiltration versus single shot femoral nerve block. Knee 20:324–327CrossRefPubMed

47.

Grevstad U, Mathiesen O, Valentiner LS, Jaeger P, Hilsted KL, Dahl JB (2015) Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, blinded study. Reg Anesth Pain Med 40:3–10CrossRefPubMed

48.

Andersen HL, Gyrn J, Møller L, Christensen B, Zaric D (2013) Continuous saphenous nerve block as supplement to single-dose local infiltration analgesia for postoperative pain management after total knee arthroplasty. Reg Anesth Pain Med 38:106–111CrossRefPubMed

49.

Al-Zahrani T, Doais KS, Aljassir F, Alshaygy I, Albishi W, Terkawi AS (2015) Randomized clinical trial of continuous femoral nerve block combined with sciatic nerve block versus epidural analgesia for unilateral total knee arthroplasty. J Arthroplasty 30:149–154CrossRefPubMed

Title: Effects of multi-site infiltration analgesia on pain management and early rehabilitation compared with femoral nerve or adductor canal block for patients undergoing total knee arthroplasty: a prospective randomized controlled trial
Authors: Donghai Li
Zhen Tan
Pengde Kang
Bin Shen
Fuxing Pei
Publication date: 01-01-2017
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 1/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-016-3278-0

At a glance: The STEP trials

Springer Medicine

Effects of multi-site infiltration analgesia on pain management and early rehabilitation compared with femoral nerve or adductor canal block for patients undergoing total knee arthroplasty: a prospective randomized controlled trial

Abstract

Purpose

Method

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2017

Total ankle arthroplasty versus ankle arthrodesis for the treatment of end-stage ankle arthritis: a meta-analysis of comparative studies

Reviews, reviewers and reviewing

Simultaneous open reduction and internal fixation and total hip arthroplasty for the treatment of osteoporotic acetabular fractures

The impact of different types of talus deformation after treatment of clubfeet

Allografts supercharged with bone-marrow-derived mesenchymal stem cells possess equivalent osteogenic capacity to that of autograft: a study with long-term follow-ups of human biopsies

One-stage bilateral versus unilateral short-stem total hip arthroplasty: comparison of migration patterns using “Ein-Bild-Roentgen-Analysis Femoral-Component-Analysis”