Single dose local infiltration of analgesia in total knee arthroplasty: Effect on early post operative pain: randomized controlled trial - Trial PACTR201701001980400

Timeline & Enrollment

Summary

Total knee arthroplasty (TKA) procedures have rapidly increased in number in the last decade and are also performed over a wider age spectrum. Post-operative pain and the treatment thereof especially in the first 24 hours remains a complex issue. Both the public and health professional¿s attitude and expectations of pain and pain control have also changed. Focus has shifted to treating pain aggressively and even preemptively.(15) A multimodal pain approach has become more important for better early pain control. Keisers and Delft did a meta-analysis of 7 RCT's with 405 patients and showed a possible decrease in pain measured on the VAS score in the first 24 hours only as well as decreased opioid use, however due to the high level of heterogeneity could not draw a firm conclusion.(3) The studies varied in the volume injected ranging between 20 ml and 152 ml. Peng Xu and Li did a meta-analysis looking at 18 trial involving 1858 TKA's and showed improved pain scores as well as earlier mobilization. However the administration method as well as the LAI content varied widely. LAI are being used regularly by knee surgeons despite variable results from these studies. The general opinion is that LAI decreases pain, but very few studies have confirmed this.(3) Furthermore there is no standardized method of giving the LAI in terms of concentration, volume and technique. We hypothesize that giving LAI is superior to Placebo, which is saline only. We will be giving weight specific doses of Bupivicaine in a structured technique explained later. Outcomes will be measured using the well validated VAS sheet and opioid consumption.

ICD-10 Classifications