Epidural Catheter Compared with Local Infiltration Analgesia for Postoperative Pain Relief in Total Knee Replacement

Background: This study compared the effects of epidural analgesia with infiltration analgesia in postoperative pain control for total knee arthroplasty.Methods and materials: A total of ۴۷ females and ۱۳ males with an average age of ۶۵.۷ years were randomly allocated into epidural (EA; n=۳۰) and local infiltration anesthesia (LIA; n=۳۰) groups. All patients received spinal anesthesia and were inserted epidural catheter. In LIA group, ۵۰mL of a mixture, containing bupivacaine, ketorolac, morphine sulfate, and epinephrine was injected in to periarticular tissue and in EA group normal saline was injected. In the EA group, after surgery, an epidural catheter was attached to the patient-controlled analgesia (PCA) infusion pump with ۲۵cc bupivacaine diluted in ۷۵mL of normal saline but in LIA group, the PCA pump of the epidural catheter contained ۱۰۰cc of normal saline, and the pump was blocked.Results: The difference in demographic data was not significant between the groups. The mean VAS score (Pain) of EA group was significantly higher than LIA group until ۱۲ hours after surgery, At ۲۴ hours, there was no significant difference between two groups, and pain of EA group was significantly lower than LIA group at ۴۸ hours after the surgery. Drainage volume and hemoglobin drops were lower in LIA group. Knee range of motion in the LIA group was not superior to that of the EA group two weeks after surgery. The patients’ ability to perform active straight leg raise had no significant difference between two groups one day after the surgery.Conclusion: Local infiltration analgesia was better than epidural for postoperative pain control at first ۱۲ hours. However, epidural analgesia could control postoperative pain more effectively at ۴۸ hours after surgery. There was no significantly difference between two groups regard to patients ability to perform straight leg rising and Knee range of motion was similar in two groups.

کلیدواژه ها:

Epidural catheter ، Local infiltration anesthesia ، Total knee replacement ، Analgesia ، spinal anesthesia ، Pain management