Local infiltration analgesia; an effective method for pain relief and patient's satisfaction after total knee arthroplasty: a randomized clinical trial

Pain is one of the greatest concerns of patients undergoing total knee arthroplasty (TKA); which is severe and intolerable within 72 hours post-surgery. Appropriate pain management is a key factor in patient''s early mobilization، launching physiotherapy، less hospital length of stay and more importantly، patient''s satisfaction. New studies with the infiltration of combined analgesic agents peri and intra-articularly has shown encouraging results in pain reduction، good clinical outcome and patient''s satisfaction. The purpose of this study was to compare the analgesic effect of locally infiltrated analgesia (I) compared with single injection femoral nerve block (F) and its impact on pain relief، patient''s satisfaction، morphine consumption and clinical outcome. This research was a double-blind randomized clinical trial on 36 consecutive patients undergone TKA divided into group (F) in which the ipsilateral femoral nerve in the inguinal area was blocked by a single injection of 20 ml ropivacaine (10 mg/ml) and group (I) which a combination of ketorolac، ropivacaine and epinephrine was injected peri and intra-articularly on the knee during TKA. Pain intensity measured by visual analog scale (VAS)، clinical outcome (based on range of motion)، morphine consumption and patient''s satisfaction of pain management after TKA were compared between the two groups. Pain intensity score (VAS) and Morphine consumption were statistically less in group I than group F during the first 6 hours and 24 hours post surgery respectively (P< 0. 05); however، group F had 12-hour VAS score of 5 which was less than group (I) by 1 grade in pain scale (VAS) (P< 0. 05). Other parameters were not statistically different in the two groups and patients'' response to our pain management protocols proved to be satisfactory in both groups. Lower level of pain and morphine consumption in group (I) during the first 24 hours post-surgery in contrast to group (F) and its ease of use by a surgeon intra-operatively، introduce local infiltration analgesia as an effective method to decrease the patient''s pain and improve patient''s satisfaction in early post-surgery period after total knee arthroplasty.