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- Essving, Per, 1960-
(författare)
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Local infiltration analgesia in knee arthroplasty
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Local infiltration analgesia (LIA) is a new technique for postoperative pain management following knee arthroplasty. LIA involves a long-acting local anesthetic (ropivacaine), a non-steroid anti-inflammatory drug (ketorolac) and epinephrine infiltrated into the knee joint during surgery and injected postoperatively via a catheter.In the first two studies, LIA was compared with placebo in unicompartmental (I) and total (II) knee arthroplasty. Postoperative pain levels, morphine consumption and the incidence of side effects were lower in the LIA groups. In addition, we found a shorter length of hospital stay in the LIA group following unicompartmental knee arthroplasty compared with placebo (I), while the time to home readiness was shorter in the LIA group following total knee arthroplasty (II). In this study, we found that the unbound venous blood concentration of ropivacaine was below systemic toxic blood concentrations in a sub-group of patients.In the third study, LIA was compared with intrathecal morphine for postoperative pain relief following total knee arthroplasty (III). Pain scores and morphine consumption were lower, length of hospital stay was shorter and patient satisfaction was higher in the LIA group.In the final study, we investigated the effect of minimally invasive surgery (MIS) compared with conventional surgery in unicompartmental knee arthroplasty (IV). Both groups received LIA. We found no statistically significant differences in postoperative pain, morphine consumption, knee function, home readiness, hospital stay or patient satisfaction.In conclusion, LIA provided better postoperative pain relief and earlier mobilization than placebo, both in unicompartmental and total knee arthroplasty. When compared to intrathecal morphine, LIA also resulted in improved postoperative pain relief and earlier mobilization. Minimally invasive surgery did not improve outcomes after unicompartmental knee arthroplasty, when both groups received LIA.
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| 2. |
- Essving, Per, 1960-, et al.
(författare)
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Local Infiltration Analgesia Versus Intrathecal Morphine for Postoperative Pain Management After Total Knee Arthroplasty : A Randomized Controlled Trial
- 2011
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Ingår i: Anesthesia and Analgesia. - : Lippincott, Williams and Wilkins. - 0003-2999 .- 1526-7598. ; 113:4, s. 926-933
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Local infiltration analgesia (LIA)-using a combination of local anesthetics, nonsteroidal anti-inflammatory drugs, and epinephrine, injected periarticularly during surgery-has become popular in postoperative pain management after total knee arthroplasty (TKA). We compared intrathecal morphine with LIA after TKA. less thanbrgreater than less thanbrgreater thanMETHODS: In this double-blind study, 50 patients scheduled to undergo TKA under spinal anesthesia were randomized into 2 groups: group M, 0.1 mg morphine was injected intrathecally together with the spinal anesthetic and in group L, LIA using ropivacaine, ketorolac, and epinephrine was infiltrated in the knee during the operation, and 2 bolus injections of the same mixture were given via an intraarticular catheter postoperatively. Postoperative pain, rescue analgesic requirements, mobilization, and home readiness were recorded. Patient-assessed health quality was recorded using the Oxford Knee Score and EQ-5D during 3 months follow-up. The primary endpoint was IV morphine consumption the first 48 postoperative hours. less thanbrgreater than less thanbrgreater thanRESULTS: Mean morphine consumption was significantly lower in group L than in group M during the first 48 postoperative hours: 26 +/- 15 vs 54 +/- 29 mg, i.e., a mean difference for each 24-hour period of 14.2 (95% confidence interval [CI] 7.6 to 20.9) mg. Pain scores at rest and on movement were lower during the first 48 hours in group L than in group M (P andlt; 0.001). Pain score was also lower when walking in group L than in group M at 24 hours and 48 hours postoperatively (P andlt; 0.001). In group L, more patients were able to climb stairs at 24 hours: 50% (11 of 22) versus 4% (1 of 23), i.e., a difference of 46% (95% CI 23.5 to 68.5) and at 48 hours: 70% (16 of 23) versus 22% (5 of 23), i.e., a difference of 48% (95% CI 23 to 73). Median (range) time to fulfillment of discharge criteria was shorter in group L than in group M, 51 (24-166) hours versus 72 (51-170) hours. The difference was 23 (95% CI 18 to 42) hours (P = 0.001). Length of hospital stay was also shorter in group L than in group M: median (range) 3 (2-17) versus 4 (2-14) days (P = 0.029). Patient satisfaction was greater in group L than in group M (P = 0.001), but no differences were found in knee function, side effects, or in patient-related outcomes, Oxford Knee score, or EQ-5D. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: LIA technique provided better postoperative analgesia and earlier mobilization, resulting in shorter hospital stay, than did intrathecal morphine after TKA.
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| 3. |
- Essving, Per, 1960-, et al.
(författare)
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Minimally invasive surgery did not improve outcome compared to conventional surgery following unicompartmental knee arthroplasty using local infiltration analgesia A randomized controlled trial with 40 patients
- 2012
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Ingår i: Acta Orthopaedica. - New York, USA : Informa Healthcare. - 1745-3674 .- 1745-3682. ; 83:6, s. 634-641
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: There has recently been interest in the advantages of minimally invasive surgery (MIS) over conventional surgery, and on local infiltration analgesia (LIA) during knee arthroplasty. In this randomized controlled trial, we investigated whether MIS would result in earlier home-readiness and reduced postoperative pain compared to conventional unicompartmental knee arthroplasty (UKA) where both groups received LIA.Patients and methods: 40 patients scheduled for UKA were randomized to a MIS group or a conventional surgery (CON) group. Both groups received LIA with a mixture of ropivacaine, ketorolac, and epinephrine given intra-and postoperatively. The primary endpoint was home-readiness (time to fulfillment of discharge criteria). The patients were followed for 6 months.Results: We found no statistically significant difference in home-readiness between the MIS group (median (range) 24 (21-71) hours) and the CON group (24 (21-46) hours). No statistically significant differences between the groups were found in the secondary endpoints pain intensity, morphine consumption, knee function, hospital stay, patient satisfaction, Oxford knee score, and EQ-5D. The side effects were also similar in the two groups, except for a higher incidence of nausea on the second postoperative day in the MIS group.Interpretation: Minimally invasive surgery did not improve outcome after unicompartmental knee arthroplasty compared to conventional surgery, when both groups received local infiltration analgesia. The surgical approach (MIS or conventional surgery) should be selected according to the surgeon's preferences and local hospital policies.
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| 4. |
- Essving, Per, 1960-, et al.
(författare)
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Minimally invasive surgery did not improve outcome compared to conventional surgery following unicompartmental knee arthroplasty when using local infiltration analgesia
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background and purpose: There has recently been focus on the advantages of minimally invasive surgery (MIS) over conventional surgery and on local infiltration analgesia (LIA) during knee arthroplasty. This prospective randomized controlled trial investigated whether MIS would result in earlier home readiness and reduced postoperative pain compared to conventional unicompartmental knee arthroplasty (UKA) where both groups received LIA. Patients and methods: 40 patients scheduled for UKA were randomized to group MIS or group CON (conventional surgery). Both groups received LIA, with a mixture of ropivacaine, ketorolac, and epinephrine, intra- and postoperatively. The primary endpoint was home readiness (time to fulfillment of discharge criteria). The patients were followed for 6 months. Results: We found no statistically significant difference in home readiness between group MIS, median (range) 24 (21–71) h compared to group CON, 24 (21–46) h. No statistically significant differences between the groups were found in the secondary endpoints: pain intensity, morphine consumption, knee function, hospital stay, patient satisfaction, Oxford Knee Score and EQ-5D. The side effects between the groups were also similar, except a higher incidence of nausea on the second postoperative day in group MIS compared with group CON. Interpretation: Minimally invasive surgery did not improve outcome after unicompartmental knee arthroplasty compared to conventional surgery, when both groups received local infiltration analgesia. The surgical approach (MIS or conventional surgery) should be selected according to surgeon’s preferences and local hospital policies. ClinicalTrials.gov. (Identifier NCT00991445).
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| 5. |
- Essving, Per, 1960-, et al.
(författare)
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Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty : a randomized double-blind study involving 48 patients
- 2010
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 81:3, s. 354-360
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Postoperative pain is often severe following total knee arthroplasty (TKA). We investigated the efficacy of local infiltration analgesia (LIA) technique, intra- and postoperatively.Methods: 48 patients undergoing TKA were randomized into 2 groups in a double-blind study. In group A, 400 mg ropivacaine, 30 mg ketorolac and 0.5 mg epinephrine were infiltrated periarticularly intra-operatively. In group P, no injections were given. At 21 hours postoperatively, 200 mg ropivacaine, 30 mg ketorolac and 0.1 mg epinephrine were injected intraarticularly in group A, and the same volume of saline was injected in group P. Patients were followed up for 3 months.Results: Median morphine consumption was lower in group A during 0-48 h: 18 (1-74) mg vs. 87 (36-160) mg in group P. Postoperative pain was lower at rest in group A during the first 27 h, and on movement during the first 48 h, except at 21 h. Time to fulfilling discharge criteria was shorter in group A than in group P; 3 (1-7) vs. 5 (2-8) days. Patient satisfaction was higher in group A compared to group P on day 1 and 7. The unbound venous blood concentration of ropivacaine was below systemic toxic blood concentrations. Interpretation: Local infiltration analgesia (LIA) technique provides excellent pain relief and lower morphine consumption following TKA, resulting in shorter time to home readiness and higher patient satisfaction. Side effects were few and systemic LA concentrations low.
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