Epidural catheter compared with local infiltration analgesia for postoperative pain relief in total knee replacement

authors:

avatar Mohammadreza Minator Sajjadi 1 , * , avatar Mohammad Reza Moshari ORCID 2 , avatar Mohammad Ali Okhovatpour 1 , avatar Reza Zandi 3 , avatar Keyvan Jalali 4

Assistant professor of Department of Orthopedics, Taleghani Hospital Research Development committee, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran.
Assistant professor, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Orthopedics Department, Taleghani Hospital Research Development committee, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran
Orthopedic surgeon, Taleghani Hospital Research Development committee, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran
Journal of Cellular & Molecular Anesthesia: Vol.4, issue 4; e149594
article type: Original Articles
DOI: https://doi.org/10.22037/jcma.v4i4.29109

how to cite: Minator Sajjadi M, Moshari M R, Okhovatpour M A, Zandi R, Jalali K. Epidural catheter compared with local infiltration analgesia for postoperative pain relief in total knee replacement. J Cell Mol Anesth. 2019;4(4):e149594. https://doi.org/10.22037/jcma.v4i4.29109.

Abstract

AbstractBackground: This study compares the effects of epidural analgesia with infiltration analgesia in postoperative pain control for total knee arthroplasty. Materials and methods: 47 females and 13 males with an average age of 65.7 years were randomly allocated into epidural (EA; n=30) and local infiltration anesthesia (LIA; n=30) groups. All patients received spinal anesthesia and were inserted epidural catheter. In LIA group, 50mL of a mixture, containing bupivacaine, ketorolac, morphine sulfate, and epinephrine was injected in to periarticular tissue and in EA group normal saline was injected. In the EA group, after surgery, an epidural catheter was attached to the patient-controlled analgesia (PCA) infusion pump with 25cc bupivacaine diluted in 75mL of normal saline but in LIA group, the PCA pump of the epidural catheter contained 100cc of normal saline, and the pump was blocked.Results: The difference in demographic data was not significant between the groups. The mean VAS score (Pain) of EA group was significantly higher than LIA group until 12 hours after surgery, At 24 hours, there was no significant difference between two groups, and Pain of EA group was significantly lower than LIA group at 48 hours after the surgery. Dranage volume and hemoglobin drops were lower in LIA group. Knee range of motion in the LIA group was not superior to that of the EA group two weeks after surgery. The patients? ability to perform active straight leg raise had no significant difference between two groups one day after the surgery.Conclusion: local infiltration analgesia is better than epidural for postoperative pain control at first 12 hours. However, epidural analgesia can control postoperative pain more effectively at 48 hours after surgery. There was no significantly difference between two groups regard to patients ability to perform straight leg rising and Knee range of motion was similar in two groups.