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Local anesthesia superior to opioids for pain management after TKA

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Patients who undergo total knee arthroplasty may benefit more from intra-articular catheters filled with bupivicaine than traditional opioids for pain management, according to researchers at the Rothman Institute at Thomas Jefferson University Hospital in Philadelphia.

Their level 1 study was presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting, where it won the Knee Society Award for best work on a surgical technique, according to a press release from Thomas Jefferson University.

The investigators studied 150 patients who underwent unilateral total knee arthroplasty and were randomized to receive an intra-articular catheter that continuously delivered either 0.5% bupivicaine or a placebo solution of 0.9% saline for 2 postoperative days. According to the release, patients filled out Visual Analog Scale questionnaires at 5 PM on the day of surgery, at 8 AM and 5 PM every postoperative day until discharge and at 4-week follow-up.

Patients who received bupivicaine had the least pain and lowest narcotics consumption. The researchers found no significant difference between the groups in terms of postoperative complications, according to the release.

“The study opens up a potential new option for better pain management post-surgery for our knee replacement patients,” Nittin Goyal, MD, one of the study authors, stated in the press release. “Though further study is needed, these initial results are promising.”

Reference:

• Goyal N, McKenzie JC, Parvizi J, et al. Efficacy of postoperative intra-articular analgesia following total knee arthroplasty. Paper #809. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.