POSTOPERATIVE PAIN RELIEF AND FUNCTIONAL OUTCOME FOLLOWING TOTAL KNEE ARTHROPLASTY - A PROSPECTIVE COMPARATIVE AUDIT OF THREE ANALGESIC REGIMES

The aim of the study was to assess the efficacy of bolus local anaesthesia, infusion in to the surgical site and nerve blocks with femoral nerve catheter and its functional outcome. A prospective audit of 114 patients undergoing total knee arthroplasty were divided in to three groups: Group 1 (n=27 ) received a bolus injection of  20ml 0.25% levobupivacaine+10ml 0.25%bupivacaine+adrenaline+30 ml saline. Group 2(n=39 )received a bolus injection as on group 1 with 240ml 0.25% bupivacaine infusion and 5ml/hour using a Pain Buster pump. Group 3(n=48 )received 30ml 0.125% levobupivacaine to femoral (3-in-1)block with 30ml 0.25% levobupivacaine to sciatic nerve and introduction of a femoral nerve catheter. All patients were prescribed paracetamol 1g QDS, Oxycontin 20mg BD and Ibuprofen post operatively. Pain was assessed with a Visual Analog Scale (VAS).The incidence of PONV was measured by PONV intensity score, The mean post-op VAS score for Group 3 was 4. The mean inpatient stay for Group 3 was 3.1 days. The PONV intensity score of >50 in 9(20%) in Group 3.Our study demonstrated that Regime 3 with the use of nerve blocks and femoral nerve catheter has given the maximum pain relief and good functional outcome following total knee replacement.