Intrathecal baclofen for postoperative analgesia after total knee arthroplasty

Area of Science:

• Anesthesiology
• Orthopedic Surgery
• Pain Management

Background:

• Postoperative pain management is crucial for patient recovery after total knee arthroplasty (TKA).
• Opioid analgesia is commonly used but associated with adverse effects and potential for chronic pain.
• Novel adjunctive strategies are needed to enhance pain control and reduce opioid dependence following TKA.

Purpose of the Study:

• To evaluate the efficacy of intrathecal baclofen (IT baclofen) as an adjunct to spinal anesthesia for reducing acute and chronic postoperative pain.
• To assess the impact of IT baclofen on opioid consumption and patient-reported pain levels after TKA.

Main Methods:

• A prospective, randomized, double-blind controlled trial was conducted.
• 60 adult patients undergoing TKA received spinal anesthesia with bupivacaine combined with either IT baclofen (100 mcg) or saline.
• Pain scores, opioid usage, and adverse events were monitored throughout the postoperative period and at a three-month follow-up.

Main Results:

• Patients receiving IT baclofen demonstrated significantly lower morphine consumption in the post-anesthesia care unit (PACU).
• While overall pain scores showed a trend towards reduction, significant differences were observed at 48-72 hours and three months postoperatively.
• At three months, the IT baclofen group reported significantly less pain (8/27 vs. 19/29, P = 0.009), with 4.5 times lower odds of reporting pain.

Conclusions:

• Intrathecal baclofen is an effective adjunctive agent for managing postoperative pain after TKA.
• IT baclofen significantly reduces acute opioid requirements and chronic pain at three months.
• This approach offers a promising strategy for improving long-term pain outcomes in TKA patients.