Local infiltration of anesthetics gives better results for pain and comfort scores then patient controlled anesthesia in total knee arthroplasty

Background : Local infiltration of anesthetics (LIA) is an upcoming alternative method for analgesia following total knee arthroplasty (TKA). It could replace patient controlled epidural anesthesia (PCEA). The advantages of LIA are faster mobilization, less risks compared to placement of an epidural catheter, and it increases patient care in a quantitative and qualitative way. On the other hand, PCEA provides prolonged analgesia postoperatively. The aim of this study was to compare the effects of LIA and PCEA on pain and comfort scores during the seven days following TKA. Methods : Two weeks after hospital dismissal, a questionnaire was sent to 116 patients who underwent TKA. Patients were asked for their pain scores on the day of surgery (=D0), two days after (=D2) and 7 days after (=D7). They were also asked about their general comfort, postoperative nausea and vomiting (PONV), vertigo and comfort urinating. The primary endpoint was pain at D7, secondary endpoints were pain on D0 and D2. and comfort scores. Results : Data of 81 patients were analyzed. 40 were provided with PCEA and 41 patients received LIA. Pain scores on D7 were significantly better in the LIA-group (18 [0-75] vs 38 [0-100] for LIA and PCEA, respectively (p=0.01)). Pain scores on D2 were also significantly better in the LIA group, whereas no difference in pain scores was seen on D0. There was less PONV on D0 and less discomfort urinating on D7 in the LIA group. Other scores showed no significant differences between the two groups. Conclusion : LIA showed in lower pain scores and improved comfort scores, compared to PCEA