J Knee Surg 2019; 32(10): 953-959
DOI: 10.1055/s-0038-1672156
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Matched-Pair Analysis of Local Infiltration Analgesia in Total Knee Arthroplasty: Patient Satisfaction and Perioperative Pain Management in 846 Cases

Felix Greimel
1  Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
,
Günther Maderbacher
1  Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
,
Clemens Baier
1  Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
,
Timo Schwarz
1  Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
,
Florian Zeman
2  Center for Clinical Studies, University Medical Center of Regensburg, Regensburg, Germany
,
Winfried Meissner
3  Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
,
Joachim Grifka
1  Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
,
Achim Benditz
1  Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
› Author Affiliations
Funding None.
Further Information

Publication History

12 June 2018

17 August 2018

Publication Date:
06 October 2018 (online)

Abstract

In the recent past, numerous studies evaluating local infiltration analgesia (LIA) with controversial results have been reported. Efforts have been made to improve patients' outcome regarding operation techniques and material, as well as pain management and anesthetic methods. In this study, postoperative pain management and patient satisfaction were evaluated in patients undergoing total knee replacement surgery with or without intraoperative LIA. Within the context of the “Quality Improvement in Postoperative Pain Management” (QUIPS) project, parameters were collected on the first postoperative day. All patients included in this study underwent primary knee replacement surgery with general anesthesia. Parameters were compared after performing a 1:1 matched-pair analysis within 14 orthopaedic departments. Pain levels and pain management satisfaction were measured using the numerous rating scales, and pain medication use was compared. From 2010 to 2015, 2,789 patients who underwent primary knee arthroplasty with general anesthesia were evaluated within the project, of whom a total of 846 patients could be compared after performing a matched-pair analysis. Pain scores were significantly better in the LIA group (p = 0.019 for activity pain, p = 0.043 for maximum pain, p < 0.001 for minimum pain), but pain management satisfaction was not superior (p = 0.083). Patients with LIA required less opioids in the recovery room (p = 0.048), while nonopioid medication did not differ significantly (p = 0.603). At the ward, 24 hours postoperatively, no significant difference in the use for nonopioids (p = 0.789) could be measured, whereas patients in the LIA group received significantly more opioids (p < 0.001). Although LIA achieved improvement in pain score outcome, and a comparable patient satisfaction level in the immediate postoperative course, the use of LIA in knee arthroplasty, controversially discussed in the current literature, was not able to reduce the need for opioid pain medication in this study.