Siriluk Toolyodpun1, Artit Laoruengthana2, Inthiporn Kositanurit3, Surachart Podjanasupawun1, Chao Saenghirunvattana4, Krit Pongpirul5,6. 1. Department of Anesthesiology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand. 2. Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand. 3. Department of Anesthesiology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand. inthipornk@nu.ac.th. 4. Department of Anesthesiology, Huachiew Hospital, Bangkok, Thailand. 5. Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 6. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Abstract
BACKGROUND: We questioned whether the triple analgesic pathways procedure via local infiltration analgesia (LIA), peripheral nerve blocks, and intrathecal morphine (ITM) is superior to LIA only for controlling pain after Total Knee Arthroplasty (TKA). METHODS: This retrospective study included 192 primary TKA patients. Group A (76 patients) received LIA only, Group B (61 patients) had ITM, adductor canal block and LIA, while Group C (55 patients) received ITM, femoral nerve block and LIA. A propensity score-matched analysis was used to compare visual analog scales (VAS) for pain intensity, total amount of morphine consumption (TMC), angle of knee flexion, and length of hospital stay (LHS). RESULTS: Group A showed significantly higher VAS than Group B at 12 h (4.27 ± 2.70 vs 2.42 ± 2.35) and 18 h (4.24 ± 2.35 vs 2.18 ± 2.02), and significantly higher than Group C at 6 h (3.46 ± 3.07 vs 0.60 ± 1.50), 12 h (4.27 ± 2.70 vs 0.89 ± 1.48), and 18 h postoperative (4.24 ± 2.35 vs 1.82 ± 2.18). However, the VAS of Group C and B converged to equalize with Group A after 12 and 18 h, respectively. The TMC at 48 h postoperative of Group A was higher than that of Group B (p < 0.01). Nevertheless, there was no difference between groups in terms of knee flexion and LHS, except the LHS of Group B was longer than Group A (p = 0.04). CONCLUSION: Triple analgesic pathways could provide a better initial analgesic profile. However, the pain seems to be rebound after resolution of nerve block and ITM, with potentially longer LHS.
BACKGROUND: We questioned whether the triple analgesic pathways procedure via local infiltration analgesia (LIA), peripheral nerve blocks, and intrathecal morphine (ITM) is superior to LIA only for controlling pain after Total Knee Arthroplasty (TKA). METHODS: This retrospective study included 192 primary TKA patients. Group A (76 patients) received LIA only, Group B (61 patients) had ITM, adductor canal block and LIA, while Group C (55 patients) received ITM, femoral nerve block and LIA. A propensity score-matched analysis was used to compare visual analog scales (VAS) for pain intensity, total amount of morphine consumption (TMC), angle of knee flexion, and length of hospital stay (LHS). RESULTS: Group A showed significantly higher VAS than Group B at 12 h (4.27 ± 2.70 vs 2.42 ± 2.35) and 18 h (4.24 ± 2.35 vs 2.18 ± 2.02), and significantly higher than Group C at 6 h (3.46 ± 3.07 vs 0.60 ± 1.50), 12 h (4.27 ± 2.70 vs 0.89 ± 1.48), and 18 h postoperative (4.24 ± 2.35 vs 1.82 ± 2.18). However, the VAS of Group C and B converged to equalize with Group A after 12 and 18 h, respectively. The TMC at 48 h postoperative of Group A was higher than that of Group B (p < 0.01). Nevertheless, there was no difference between groups in terms of knee flexion and LHS, except the LHS of Group B was longer than Group A (p = 0.04). CONCLUSION: Triple analgesic pathways could provide a better initial analgesic profile. However, the pain seems to be rebound after resolution of nerve block and ITM, with potentially longer LHS.
Authors: Stavros G Memtsoudis; Crispiana Cozowicz; Janis Bekeris; Dace Bekere; Jiabin Liu; Ellen M Soffin; Edward R Mariano; Rebecca L Johnson; Mary J Hargett; Bradley H Lee; Pamela Wendel; Mark Brouillette; George Go; Sang J Kim; Lila Baaklini; Douglas Wetmore; Genewoo Hong; Rie Goto; Bridget Jivanelli; Eriphyli Argyra; Michael J Barrington; Alain Borgeat; Jose De Andres; Nabil M Elkassabany; Philippe E Gautier; Peter Gerner; Alejandro Gonzalez Della Valle; Enrique Goytizolo; Paul Kessler; Sandra L Kopp; Patricia Lavand'Homme; Catherine H MacLean; Carlos B Mantilla; Daniel MacIsaac; Alexander McLawhorn; Joseph M Neal; Michael Parks; Javad Parvizi; Lukas Pichler; Jashvant Poeran; Lazaros A Poultsides; Brian D Sites; Otto Stundner; Eric C Sun; Eugene R Viscusi; Effrossyni G Votta-Velis; Christopher L Wu; Jacques T Ya Deau; Nigel E Sharrock Journal: Br J Anaesth Date: 2019-07-24 Impact factor: 9.166
Authors: Jerry Yongqiang Chen; Pak Lin Chin; Ing How Moo; Hee Nee Pang; Darren Keng Jin Tay; Shi-Lu Chia; Ngai Nung Lo; Seng Jin Yeo Journal: Knee Date: 2015-12-30 Impact factor: 2.199