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Continuous anesthetic after TKA did not impact postoperative pain in pilot study
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Canadian researchers of this randomized, controlled trial concluded that a 48-hour intra-articular infusion of bupivacaine after total knee arthroplasty was ineffective in improving patients’ outcome scores and decreasing 48-hour postoperative morphine consumption.
“While the literature is conflicted over the efficacy of a continuous infusion of local anesthetic on postoperative pain and opioid use after total knee arthroplasty, the results of the current study did not show any benefit to intra-articular infusions of local anesthetic after primary total knee replacement, nor did it show any negative effects,” Dale Williams, MD, FRCSC, and colleagues wrote in their study.
Of the 67 patients enrolled in the trial, 35 patients received bupivacaine and 32 patients received a placebo. There were no significant differences between the groups regarding 48-hour postoperative morphine consumption and Visual Analog Scale pain scores at 6 hours to 8 hours, 24 hours and 48 hours after surgery. Length of hospital stay was comparable between the groups – the bupivacaine stayed a mean 4.7 days and the placebo group stayed mean 3.9 days. The investigators also found that the anesthetic did not improve knee function scores.
“Given study results, we would conclude that analgesia outcomes with a multimodal analgesia regimen are not significantly improved by adding 48-[hours] of 0.5% bupivacaine infiltration at 2 cc/h,” the authors wrote.
Disclosure: One of the authors (de Beers) is on the speaker’s bureau for and receives research support from Stryker Canada.
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