The effect of peri-operative analgesia technique on outcomes following total knee arthroplasty.

The effect of peri-operative analgesia technique on outcomes following total knee arthroplasty.

McDonald DA, Deakin AH, Ellis BM, Robb Y, Howe TE, Kinninmonth AW, Scott NB. The technique of delivery of peri-operative analgesia does not affect the rehabilitation or outcomes following total knee arthroplasty. Bone Joint J. 2016 Sep;98-B(9):1189-96.

What is already known:

The introduction of ERAS programs in patient’s undergoing total knee arthroplasty have been shown to significantly reduce perioperative morbidity and mortality. During the implementation of these programs however, multiple aspects of perioperative care are altered simultaneously making it difficult to ascertain which components of the program are most important in achieving optimal outcomes.

What this paper adds:

This study was a non-blinded single-center randomised controlled trial comparing the outcomes of patient controlled epidural anaesthesia (PCEA) vs local anaesthetic infiltration (LAI) in total knee arthroplasty within an already established ERAS program.

There were no significant differences between the two groups. Variables analysed included length of stay, range of knee movement, additional analgesia requirements, nausea, time to discharge and one year follow up. This is one of the first trials to look at using epidurals without a background infusion; this technique appears to allow safe mobilization to occur earlier than has been seen in other trials where delayed mobilization following epidurals has often been a concern.

Emma Stewart, Guildford.