The technique of delivery of peri-operative analgesia does not affect the rehabilitation or outcomes following total knee arthroplasty.
2016
Aims This non-blinded randomised controlled trial compared the effect
of patient-controlled epidural analgesia (PCEA) versus local
infiltration analgesia (LIA) within an established enhanced recovery
programme on the attainment of discharge criteria and recovery one
year after total knee arthroplasty (TKA). The hypothesis was that
LIA would increase the proportion of patients discharged from rehabilitation
by the fourth post-operative day but would not affect outcomes at
one year. Patients and Methods A total of 242 patients were randomised; 20 were excluded due
to failure of spinal anaesthesia leaving 109 patients in the PCEA
group and 113 in the LIA group. Patients were reviewed at six weeks
and one year post-operatively. Results There was no difference in the proportion of patients discharged
from rehabilitation by the fourth post-operative day, (77% in the
PCEA group, 82% in the LIA group, p = 0.33), mean length of stay
(four days in each group, p = 0.540), day of first mobilisation
(p = 0.013) or pain (p = 0.278). There was no difference in mean
Oxford Knee Scores (41 points in each group, p = 0.915) or the rate
of complications in the two groups. Conclusion Both techniques provided adequate pain relief, enabled early
mobilisation and accelerated rehabilitation and good patient-reported
outcomes up to one year post-operatively. PCEA and LIA are associated
with similar clinical outcomes following TKA. Cite this article: Bone Joint J 2016;98-B1189–96.
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