Aims Multimodal infiltration of local anaesthetic provides effective control of pain in patients undergoing total knee arthroplasty (TKA). There is little information about the added benefits of posterior capsular infiltration (PCI) using different combinations of local anaesthetic agents. Our aim was to investigate the effectiveness of the control of pain using multimodal infiltration with and without infiltration of the posterior capsule of the knee.
Patients and Methods In a double-blind, randomised controlled trial of patients scheduled for unilateral primary TKA, 86 were assigned to be treated with multimodal infiltration with (Group I) or without (Group II) PCI. Routine associated analgesia included the use of bupivacaine, morphine, ketorolac and epinephrine. All patients had spinal anaesthesia and patient-controlled analgesia (PCA) post-operatively. A visual analogue scale (VAS) for pain and the use of morphine were recorded 24 hours post-operatively. Side effects of the infiltration, blood loss, and length of stay in hospital were recorded.
Results There were no statistically significant differences between the groups in relation to: VAS pain scores in the first 24 hours post-operatively (p = 0.693), the use of morphine in the PCA (p = 0.647), blood loss (p = 0.625), and length of stay (p = 0.17). There were no neurovascular complications in either group.
Conclusion The multimodal infiltration of local anaesthetic with infiltration of the posterior capsule did not provide significant added analgesic benefits or reduce the use of morphine after TKA. Multimodal infiltration is a satisfactory technique for the management of pain in these patients without the attendant risks of PCI.
Cite this article: Bone Joint J 2017; 99-B:483–8.
- Multimodal anaesthesia
- Local anaesthetic infiltration
- Posterior capsular infiltration
- Knee arthroplasty
- Pain control
P. Pinsornsak: Conception or design of the work, Drafting the article, Critical revision of the article, Final approval of the version to be published.
S. Nangnual: Data collection.
K. Boontanapibul: Data analysis and interpretation.
We thank J. Patumanond MD, for help with computerised block randomisation and the statistical analysis as well as A. Seangleulur MD, P. Arunakul MD, S. Manuwong MD for anaesthesia procedures and V. Burapan RN, for opening the sealed opaque envelopes in the operating theatre.
We also thank B. Taylor MD, and D. Kim Liwiski for reviewing the manuscript, and all study participants.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by S. P. F. Hughes and first proof edited by J. Scott.
- Received September 3, 2016.
- Accepted January 6, 2017.
- ©2017 The British Editorial Society of Bone & Joint Surgery