Postoperative pain control by intra-articular local anesthesia versus femoral nerve block following total knee arthroplasty: Impact on discharge

Introduction: The goal of this retrospective study was to compare pain control following total knee arthroplasty (TKA) on a perioperative protocol of local anesthesia (LA) versus the more classical femoral nerve block (FNB) technique. Hypothesis: Fitness for discharge would be achieved earlier using the LA protocol. Materials: Ninety-eight consecutive TKA patients operated on by a single surgeon were included with no selection criteria. In the study group (49 patients), 200 mL ropivacaine 5% was injected into the surgical wound and an intra-articular catheter was fitted to provide continuous infusion of 20 mL/h ropivacaine for 24 h. The control group (49 patients) received ropivacaine FNB. Discharge fitness (independent walking, knee flexion > 90 degrees quadricipital control, pain on VAS <= 3) and hospital stay were assessed. Results: Discharge fitness was achieved significantly earlier in the study group (4.2 +/- 2.6 versus 6.7 +/- 3.2 days; P = 0.0003), with significantly shorter mean hospital stay (6.1 +/- 3.4 versus 8.8 +/- 3.5 days; P = 0.0002). The complications rate did not differ between study and control groups. Discussion: Although retrospective, this study indicates that the LA protocol improves management of post TKA pain and accelerates rehabilitation, thereby, reducing hospital stay. The acceleration effect maybe due to the absence of quadriceps inhibition. (C) 2014 Elsevier Masson SAS. All rights reserved.