Continuous intra-articular infusion anesthesia for pain control after total knee arthroplasty: study protocol for a randomized controlled trial

Trials

Jun Liu¹  Jian-Ke Pan¹  Wen-Wei Ouyang²  Jin-Wen Liu¹  Xue-Wei Cao¹  Da Guo¹ 

[1] Department of Orthopedic Surgery, The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, Guangdong 510120, China;The Clinical Epidemiology Application Laboratory, The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, Guangdong 510120, China

关键词: Randomized controlled trial;    Continuous intra-articular infusion anesthesia;    Postoperative pain control;    Total knee arthroplasty;   

Others  :  802481
DOI  :  10.1186/1745-6215-15-245

 received in 2013-12-29, accepted in 2014-06-09,  发布年份 2014

【 摘 要 】

Background

Postoperative pain control after total knee arthroplasty (TKA) remains a great challenge. The management of pain in the immediate postoperative period is one of the most critical aspects to allow speedier rehabilitation and reduce the risk of postoperative complications. Recently, periarticular infiltration anesthesia has become popular, but the outcome is controversial. Some studies have shown transient effects, “rebound pain”, or no effectiveness in pain control. Continuous intra-articular infusion technique has been introduced to improve these transient effects, but more clinical studies are needed. Furthermore, the potential risk of early periprosthetic joint infection is causing concerning. We plan to compare continuous intra-articular infusion anesthesia with epidural infusion anesthesia after TKA to assess the effectiveness of this technique in reducing pain, in improving postoperative function, and to look at the evidence for risk of early infection.

Methods/design

This trial is a randomized, controlled study. Patients (n = 214) will be randomized into two groups: to receive continuous intra-articular infusion anesthesia (group C); and epidural infusion anesthesia (group E). For the first 3 postoperative days, pain at rest, active range of motion (A-ROM), rescue analgesia and side effects will be recorded. At 3-month and 6-month follow-up, A-ROM, C-reactive protein, erythrocyte sedimentation rate, and synovial fluid cell count and culture will be analyzed.

Discussion

The results from this study will provide clinical evidence on the efficacy of a continuous intra-articular infusion technique in reducing pain, postoperative functional improvement and safety. It will be the first randomized controlled trial to investigate infection risk with local anesthesia after TKA.

Trial registration

ClinicalTrials.gov identifier: ChiCTR-TRC-13003999

【 授权许可】

   
2014 Guo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Beaussier M: Frequency, intensity, development and repercussions of postoperative pain as a function of the type of surgery [in French]. Ann Fr Anesth Reanim 1998, 17:471-493.
• [2]Brasseur L, Boukhatem P: The epidemiology of postoperative pain [in French]. Ann Fr Anesth Reanim 1998, 17:534-539.
• [3]Davies AF, Segar EP, Murdoch J, Wright DE, Wilson IH: Epidural infusion or combined femoral and sciatic nerve blocks as perioperative analgesia for knee arthroplasty. Br J Anaesth 2004, 93:368-374.
• [4]Ilfeld BM, Gearen PF, Enneking F, Kayser MD, Berry LF, Spadoni EH, George SZ, Vandenborne K: Total knee arthroplasty as an overnight-stay procedure using continuous femoral nerve blocks at home: a prospective feasibility study. Anesth Analg 2006, 102:87-90.
• [5]Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM: Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg 1998, 87:88-92.
• [6]Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, Rorabeck CH, McCalden RW: Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 2006, 88:959-963.
• [7]Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, Varin F: A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 2006, 88:282-289.
• [8]Goyal N, McKenzie J, Sharkey PF: The 2012 Chitranjan Ranawat award: intraarticular analgesia after TKA reduces pain: a randomized, double-blinded, placebo-controlled, prospective study. Clin Orthop Relat Res 2013, 471:64-75.
• [9]Andersen KV, Pfeiffer-Jensen M, Haraldsted V, Soballe K: Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty: a randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients. Acta Orthop 2007, 78:180-186.
• [10]Andersen LJ, Poulsen T, Krogh B, Nielsen T: Postoperative analgesia in total hip arthroplasty: a randomized double-blinded, placebo-controlled study on peroperative and postoperative ropivacaine, ketorolac, and adrenaline wound infiltration. Acta Orthop 2007, 78:187-192.
• [11]Reilly KA, Beard DJ, Barker KL, Dodd CA, Price AJ, Murray DW: Efficacy of an accelerated recovery protocol for Oxford unicompartmental knee arthroplasty - a randomised controlled trial. Knee 2005, 12:351-357.
• [12]Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tonnesen EK, Soballe K: Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop 2007, 78:172-179.
• [13]Andersen KV, Bak M, Christensen BV, Harazuk J, Pedersen NA, Soballe K: A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty. Acta Orthop 2010, 81:606-610.
• [14]Gomez-Cardero P, Rodriguez-Merchan EC: Postoperative analgesia in TKA: ropivacaine continuous intraarticular infusion. Clin Orthop Relat Res 2010, 468:1242-1247.
• [15]Bianconi M, Ferraro L, Traina GC, Zanoli G, Antonelli T, Guberti A, Ricci R, Massari L: Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery. Br J Anaesth 2003, 91:830-835.
• [16]Isaac D, Falode T, Liu P, I’Anson H, Dillow K, Gill P: Accelerated rehabilitation after total knee replacement. Knee 2005, 12:346-350.
• [17]Rasmussen S, Kramhoft MU, Sperling KP, Pedersen JH: Increased flexion and reduced hospital stay with continuous intraarticular morphine and ropivacaine after primary total knee replacement: open intervention study of efficacy and safety in 154 patients. Acta Orthop Scand 2004, 75:606-609.
• [18]Lombardi AV Jr, Berend KR, Mallory TH, Dodds KL, Adams JB: Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop 2004, 428:125-130.
• [19]Romsing J, Moiniche S, Ostergaard D, Dahl JB: Local infiltration with NSAIDs for postoperative analgesia: evidence for a peripheral analgesic action. Acta Anaesthesiol Scand 2000, 44:672-683.
• [20]Weston-Simons JS, Pandit H, Haliker V, Dodd CA, Popat MT, Murray DW: Intra-articular local anaesthetic on the day after surgery improves pain and patient. Knee 2012, 19:352-355.
• [21]Joo JH, Park JW, Kim JS, Kim YH: Is intra-articular multimodal drug injection effective in pain management after total knee arthroplasty? A randomized, double-blinded, prospective study. J Arthroplasty 2011, 26:1095-1099.
• [22]Chapman CR, Casey KL, Dubner R, Foley KM, Gracely RH, Reading AE: Pain measurement: an overview. Pain 1985, 22(1):1-31.
• [23]Huskisson EC: Measurement of pain. Lancet 1974, 2:1127.
• [24]Sriwatanakul K, Kelvie W, Lasagna L, Calimlim JF, Weis OF, Mehta G: Studies with different types of visual analog scales for measurement of pain. Clin Pharmacol Ther 1983, 34:234.
• [25]Choi PT, Bhandari M, Scott J, Douketis J: Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev 2003., 3(3)
• [26]Essving P, Axelsson K, Kjellberg J, Wallgren O, Gupta A, Lundin A: Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplasty. Acta Orthop 2009, 80:213-219.