Local infusion analgesia using intra-articular double lumen catheter after total knee arthroplasty: a double blinded ran
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KNEE
Local infusion analgesia using intra-articular double lumen catheter after total knee arthroplasty: a double blinded randomized control study Masahiko Ikeuchi • Yuko Kamimoto • Masashi Izumi • Natsuki Sugimura • Mizue Takemura • Kayo Fukunaga Masataka Yokoyama • Toshikazu Tani
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Received: 6 December 2011 / Accepted: 2 April 2012 Ó Springer-Verlag 2012
Abstract Purpose Although intra-operative local infiltration analgesia has gained increasing popularity in joint replacement surgery, it is not clear whether postoperative local infusion analgesia using an indwelling catheter provides clinically important additional effects. We, therefore, conducted a randomized controlled trial to clarify the efficacy of the originally developed local infusion analgesia technique in total knee arthroplasty. Methods Forty patients were randomly allocated to the local infusion analgesia or control group. Patients in the local infusion analgesia group received intermittent bolus intra-articular injection of analgesics consisting of ropivacaine, dexamethasone, and isepamicin until postoperative 48 h. Primary outcome was pain severity at rest using 100-mm visual analogue scale. Results Pain severity in patients of the local infusion analgesia group was lower than control group, and there were significant differences between groups at POD1 (p = 0.025) and POD3 (p = 0.007). Reduction of postoperative pain was associated with a decrease in C-reactive protein level and earlier achievement of straight leg raise. In addition, postoperative drain volume was reduced in the local infusion analgesia group. Conclusion Although larger studies are needed to examine its safety, the local infusion analgesia alone provided
M. Ikeuchi (&) M. Izumi N. Sugimura T. Tani Department of Orthopedic Surgery, Kochi University, 185-1 Oko-cho, Nankoku, Kochi 783-8505, Japan e-mail: [email protected] Y. Kamimoto M. Takemura K. Fukunaga M. Yokoyama Department of Anesthesiology, Kochi University, Kochi, Japan
clinically significant analgesic effects and rapid recovery in total knee arthroplasty. Level of evidence Randomized controlled trial, Level I. Keywords Total knee arthroplasty Postoperative pain Analgesia Recovery Randomized controlled trial
Introduction Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain [24]. Pain management is essential for early recovery and patient satisfaction. Recently, local infiltration analgesia was introduced as a promising method [12]. Original technique consists of intra-operative high-volume local infiltration analgesia followed by postoperative local infusion analgesia through an indwelling catheter. Although they achieved excellent analgesia and fast recovery after TKA, it is not clear whether postoperative local infusion analgesia provides clinically important additional effects. In addition, because the original technique was performed without wound drain, large volume of local analgesics was injected into the swollen joint cavity and diluted greatly with bl
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