Authors: Keith R Reinhardt Shivi Duggal BenPaul Umunna Gregory A Reinhardt Denis Nam Michael Alexiades Charles N Cornell
Publish Date: 2013/10/26
Volume: 472, Issue: 5, Pages: 1400-1408
Abstract
Ninetyfour patients undergoing unilateral TKA were prospectively randomized to receive a spinalepidural analgesic infusion plus a singleinjection FNB or a spinal anesthetic plus a continuous postoperative intraarticular infusion of 02 ropivacaine All patients were blinded to their treatment with placebo saline catheters Blinded coinvestigators collected data concerning side effect profiles nausea hypotension analgesic efficacy VAS pain scores narcotic usage and functional recovery timed up and go test quadriceps strength WOMAC scores Knee Society scores early postoperative ambulatory ability inhospital falls All complications and adverse events were recordedThe frequency of nausea and hypertension was not different between the study groups During the first 12 and 24 postoperative hours the mean maximum VAS pain scores were higher in the ropivacaine group than in the epidural group first 12 hours 393 versus 114 respectively p 00001 12–24 hours 352 versus 193 respectively p = 0008 After 24 hours pain scores were similar between groups Narcotic consumption was significantly higher in the ropivacaine group on the day of surgery but overall inhospital narcotic usage was similar between groups There were no clinically important differences in functional recovery between groups at any time point but patients in the epidural group were more likely to have knee buckling 327 versus 67 p = 0002 and delayed ambulation 163 versus 00 p = 0006 than patients in the ropivacaine group though not inhospital falls No infections occurred in either group and the frequency of complications was not different between groupsA continuous intraarticular infusion of ropivacaine can be recommended as a safe effective alternative to epidural analgesia plus singleinjection FNB after TKA Improved analgesic efficacy in the group that received epidural analgesia plus singleinjection FNB must be weighed against the disadvantage of a higher likelihood of knee buckling and delayed ambulation with that treatment approachThe institution of one or more of the authors KRR SD GAR DN MA CNC has received during the study period funding from three institutional research grants namely the Hospital for Special Surgery Adult Reconstruction and Joint Replacement Division research grant the Surgeoninchief fund research grant and the Eduardo A Salvati MD resident research grant The authors did not receive outside commercial funding in support of the research for or preparation of this manuscriptEach author certifies that he or she or a member of his or her immediate family has no commercial associations eg consultancies stock ownership equity interest patent/licensing arrangements etc that might pose a conflict of interest in connection with the submitted article
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