Lokale Infiltrationsanästhesie (LIA) für Hüft- und Kniegelenksendoprothesen – Eine kurze Übersicht über den aktuellen Stand

Zusammenfassung

Die lokale Infiltrationsanästhesie (LIA) erfolgt intraoperativ durch den Chirurgen, der 150ml (300mg Ropivacain, 30mg Ketorolac und 0,5 mg Adrenalin) in Knochen, Knorpel, Bänder, Muskulatur, Subkutis injiziert. Ein strammer Verband und eine Eiskühlung für 4–6h verlängern die Analgesiedauer, ± 5h nach der Operation wird mobilisiert. Neben großen Anwendungsbeobachtungen existieren 11 randomisierte Studien in der Hüft- und Knieendoprothetik im Vergleich zur systemischen Analgesie, Epidural- oder peripheren Regionalanästhesie, allesamt mit positivem Ergebnis für die LIA. Zudem ist die LIA sicher, preisgünstig und erfordert keine besonderen technischen Fertigkeiten im Vergleich zur Epidural- und peripheren Regionalanästhesie.

Abstract

Local infiltration analgesia (LIA) is usually performed intraoperatively by the surgeon who injects 150 mL (300 mg Ropivacain, 30 mg Ketorolac and 0.5 mg adrenalin) into the bone, cartilage, ligament, musculature, or hyperdermis. A tight bandage and ice cooling for 4 – 6 hours lengthen the duration of analgesia, mobilisation can be undertaken about 5 hours after the operation. Besides large observation-in-use studies, there are 11 randomised studies in the fields of total hip and knee arthroplasty that report comparisons with systemic analgesia as well as with epidural or peripheral anaesthesia, all of which showed positive results for LIA. In addition LIA is safe, has favourable costs and does not require any special technical abilities in contrast to epidural and peripheral regional anaesthesia.

Schlüsselwörter:

lokale Infiltrationsanästhesie (LIA) - Hüftgelenks-Endoprothesen - Kniegelenks-Endoprothesen - postoperative Schmerztherapie - funktionelles Ergebnis

Key words:

high volume local infiltration anaesthesia (LIA) - hip arthroplasty - knee arthroplasty - postoperative pain management - functional outcome

Literatur

• 1 Reily KA, Beard DJ, Barker KL et al.. Efficacy of an accelerated recovery protocol for Oxford unicompartmental knee arthroplasty– a randomised controlled trial.  Knee. 2005;  12 351-357
• 2 Vendittoli PA, Makinen P, Lavigne M et al.. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study.  J Bone Joint Surg. 2006;  88 282-289
• 3 Busch CA, Shore BJ, Bhandari R et al.. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial.  J Bone Joint Surg. 2006;  88 959-963
• 4 Röstlund T, Kehlet H. High-dose local infiltration analgesia after hip and knee replacement – what is it, why does it work, and what are the future challenges? Guest editorial.  Acta Orthopaedica. 2007;  78 159-161
• 5 Peters CL, Shirley B, Erickson J. The effect of a new multimodal perioperative anesthetic regimen on postoperative pain, side effects, rehabilitation and lenght of hospital stay after total joint arthroplasty.  J Arthroplasty. 2006;  21 (S 02) 132-138
• 6 Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery. A case study of 325 patients.  Acta Orthopaedica. 2008;  79 174-183
• 7 Andersen LO, Gaarn-Larsen L, Kristensen BB et al.. Subacute pain and function after fast-track hip and knee arthroplasty.  Anaesthesia. 2009;  64 508-513
• 8 Parvataneni HK, Shah VP, Howard H et al.. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections. A prospective randomized study.  J Arthroplasty. 2007;  22 (S 02) 33-38
• 9 Andersen KV, Pfeiffer-Jensen M, Haraldsted V, Soballe K. Reduced hospital stay and consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty. A randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients.  Acta Orthopaedica. 2007;  78 180-186
• 10 Andersen LO, Husted H, Otte KS et al.. High-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial.  Acta Anaesthesiol Scand. 2008;  52 1331-1335
• 11 Essving P, Axelsson K, Kjellberg J et al.. Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty. A randomized double-blind study involving 48 patients.  Acta Orthopaedica. 2010;  81 354-360
• 12 Essving P, Axelsson K, Kjellberg J et al.. Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplasty. A randomized double-blind study of 40 patients.  Acta Orthopaedica. 2009;  80 213-219
• 13 Toftdahl K, Nikolajsen L, Haraldsted V et al.. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty. A randomized controlled trial.  Acta Orthopaedica. 2007;  78 172-179
• 14 Carli F, Clemente A, Asenjo JF et al.. Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs. continuous femoral nerve block.  Br J Anaesth. 2010;  105 185-195
• 15 Andersen KV, Bak M, Christensen BV et al.. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty.  Acta Orthopaedica. 2010;  81 606-610
• 16 Spreng UJ, Dahl V, Hjall A et al.. High-volume local infiltration analgesia combined with intravenous or local ketorolac+morphine compared with epidural analgesia after total knee arthroplasty.  Br J Anaesth. 2010;  105 675-682