There is controversy in the literature regarding the role of single local infiltration analgesia (LIA) after total knee replacement (TKR).
Questions/Purposes
Is single LIA really efficient in controlling pain after TKR?
Methods
A Cochrane Library and PubMed (MEDLINE) search related to the justification LIA after TKR was analyzed. The main criteria for selection were that the articles were focused in the aforementioned question.
Results
Two hundred ninety-nine articles were found until February 9, 2017, but only 27 were selected and reviewed because they were focused on clinical experience with LIA following TKR. Fifteen of them were considered level of evidence (I-II) while 12 had a lower level of evidence (III-IV). LIA reduced the amount of perioperative opioid administration and enabled adequate pain management in conjunction with oral medication without adverse effects. No clinically marked effects on the functional outcome after TKR were detected.
Conclusion
Single dose LIA provides effective analgesia in the initial postoperative period after TKR in most randomized clinical trials, systematic reviews, and meta-analyses.
AndersenKVNikolajsenLHaraldstedVOdgaardASøballeKLocal infiltration analgesia for total knee arthroplasty: should ketorolac be added?Br J Anaesth.2013111242–810.1093/bja/aet030
2.
AndersenLØKehletHAnalgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic reviewBr J Anaesth.2014113360–7410.1093/bja/aeu155
3.
BhuttaMAAjwaniSHShepardGJRyanWGReduced blood loss and transfusion rates: Additional benefits of local infiltration anaesthesia in knee arthroplasty patientsJ Arthroplasty.2015302034–710.1016/j.arth.2015.05.025
4.
EssvingPAxelssonKKjellbergJWallgrenOGuptaALundinAReduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplastyActa Orthop.201081354–6010.3109/17453674.2010.4872412876839
5.
FuPWuYWuHLiXQianQZhuYEfficacy of intra-articular cocktail analgesic injection in total knee arthroplasty—a randomized controlled trialKnee.200916280–410.1016/j.knee.2008.12.012
6.
Gomez-BarrenaEOrtega-AndreuMPadilla-EguiluzNGPérez-ChrzanowskaHFigueredo-ZalveRTopical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement: a double-blind, randomized, controlled, noninferiority clinical trialJ Bone Joint Surg Am.2014961937–4410.2106/JBJS.N.00060
7.
KeijsersRvan DelftRvan den BekeromMPde VriesDCBrohetRMNoltePALocal infiltration analgesia following total knee arthroplasty: effect on post-operative pain and opioid consumption—a meta-analysisKnee Surg Sports Traumatol Arthrosc.2015231956–6310.1007/s00167-013-2788-1
8.
KeijsersRvan den BekeromMvan DelftRvan LottenMRademakersMNoltePAContinuous local infiltration analgesia after TKA: A meta-analysisJ Knee Surg.201629310–21
9.
KohIJKangYGChangCBDoSHSeongSCKimTKDoes periarticular injection have additional pain relieving effects during contemporary multimodal pain control protocols for TKA?: A randomised, controlled studyKnee.201219253–910.1016/j.knee.2011.03.007
10.
MilaniPCastelliPSolaMInvernizziMMassazzaGCisariCMultimodal analgesia in total knee arthroplasty: A randomized, double-blind, controlled trial on additional efficacy of periarticular anesthesiaJ Arthroplasty.2015302038–4210.1016/j.arth.2015.05.035
11.
MoráisSOrtega-AndreuMRodríguez-MerchánECPadilla-EguiluzNGPérez-ChrzanowskaHFigueredo-ZalveRGómez-BarrenaEBlood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approachInt Orthop.201438347–5410.1007/s00264-013-2188-7
12.
MulfordJSWatsonABroeDSolomonMLoeflerAHarrisIShort-term outcomes of local infiltration anaesthetic in total knee arthroplasty: a randomized controlled double-blinded controlled trialANZ J Surg.201686152–610.1111/ans.13384
13.
NakaiTTamakiMNakamuraTNakaiTOnishiAHashimotoKControlling pain after total knee arthroplasty using a multimodal protocol with local periarticular injectionsJ Orthop.20131092–410.1016/j.jor.2013.02.0013772555
14.
NiemeläinenMKalliovalkamaJAhoAJMoilanenTEskelinenASingle periarticular local infiltration analgesia reduces opiate consumption until 48 hours after total knee arthroplasty. A randomized placebo-controlled trial involving 56 patientsActa Orthop.201485614–910.3109/17453674.2014.9613994259019
15.
Ortega-AndreuMPérez-ChrzanowskaHFigueredoRGómez-BarrenaEBlood loss control with two doses of tranexamic acid in a multimodal protocol for total knee arthroplastyOpen Orthop J.2011544–810.2174/18743250011050100443087309
16.
Ortega-AndreuMTalaveraGPadilla-EguiluzNGPerez-ChrzanowskaHFigueredo-GalveRRodriguez-MerchánECGómez-BarrenaETranexamic acid in a multimodal blood loss prevention protocol to decrease blood loss in revision total knee arthroplasty: A cohort studyOpen Orthop J.201610439–44710.2174/18743250016100104395039954
17.
ParvataneniHKShahVPHowardHColeNRanawatASRanawatCSControlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized studyJ Arthroplasty.2007226 Suppl 233–810.1016/j.arth.2007.03.034
18.
QuinnMDeakinAHMcDonaldDACunninghamIKPayneAPPicardFAn anatomic study of local infiltration analgesia in total knee arthroplastyKnee.201320319–2310.1016/j.knee.2013.06.008
19.
Rodriguez-MerchanECOrtega-AndreuMPadilla-EguiluzNGGomez-CarderoPMartinez-LloredaÁGomez-BarrenaELow-volume formulation of intra-articular tranexamic acid, 25-ml tranexamic acid (2.5 g) plus 20-ml saline, is effective in decreasing blood transfusion rate in primary total knee replacement even without preoperative haemoglobin optimizationBlood Coagul Fibrinolysis.201627660–610.1097/MBC.0000000000000457
20.
Rodriguez-MerchanECRomero-GarridoJAGomez-CarderoPMultimodal blood loss prevention approach including intra-articular tranexamic acid in primary total knee arthroplasty for patients with severe haemophilia AHaemophilia.201622e318–2010.1111/hae.12942
21.
Schotanus MG, Bemelmans YF, van der Kuy PH, Jansen J, Kort NP. No advantage of adrenaline in the local infiltration analgesia mixture during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2015 Jul 26. doi:10.1007/s00167-015-3723-4
22.
SongMHKimBHAhnSJYooSHKangSWKimYJKimDHPeri-articular injections of local anaesthesia can replace patient-controlled analgesia after total knee arthroplasty: a randomised controlled studyInt Orthop.201640295–910.1007/s00264-015-2940-2
23.
SuthersanMPitSGordonLLomanMPezzuttiBFreihautRLocal infiltration analgesia versus standard analgesia in total knee arthroplastyJ Orthop Surg (Hong Kong).201523198–20110.1177/230949901502300217
24.
TengYJiangJChenSZhaoLCuiZKhanMSDuWGaoXWangJXiaYPeriarticular multimodal drug injection in total knee arthroplastyKnee Surg Sports Traumatol Arthrosc.2014221949–5710.1007/s00167-013-2566-0
25.
TripuraneniKRWoolsonSTGioriNJLocal infiltration analgesia in TKA patients reduces length of stay and postoperative pain scoresOrthopedics.20113417310.3928/01477447-20110124-11
26.
VaishyaRWaniAMVijayVLocal infiltration analgesia reduces pain and hospital stay after primary TKA: randomized controlled double blind trialActa Orthop Belg.201581720–9
27.
XuCPLiXWangZZSongJQYuBEfficacy and safety of single-dose local infiltration of analgesia in total knee arthroplasty: a meta-analysis of randomized controlled trialsKnee201421636–4610.1016/j.knee.2014.02.024
