Periarticular injection in knee arthroplasty improves quadriceps function.

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Pain Management

Background:

• The efficacy of periarticular anesthetic infiltration (PAI) for postoperative pain management following total knee arthroplasty (TKA) remains uncertain.
• Complications associated with continuous femoral nerve blocks, particularly concerning quadriceps function, require further investigation.

Purpose of the Study:

• To compare the postoperative pain control efficacy of PAI versus femoral nerve block in TKA patients.
• To evaluate if PAI enhances early postoperative quadriceps control and facilitates rehabilitation compared to femoral nerve block.

Main Methods:

• A randomized study involving 60 TKA patients allocated to either PAI or femoral nerve block.
• Comparison of narcotic consumption, pain scores, quadriceps function, mobility, and range of motion over the first 5 days post-TKA.
• Assessment of medication side effects, complications, operating room time, and hospitalization duration.

Main Results:

• PAI group showed lower opioid consumption and pain at rest in the initial 8 hours post-TKA.
• No significant difference in pain and narcotic use between groups from 8 to 120 hours.
• Femoral nerve block group had a higher incidence of quadriceps motor block (37% vs. 0%).
• PAI group demonstrated improved straight leg raise, active knee extension, and walking distance on Days 1-3.

Conclusions:

• PAI provides equivalent pain control to femoral nerve block after TKA.
• PAI avoids the motor block complications associated with femoral nerve blocks, leading to better early functional recovery.
• PAI is a viable alternative to femoral nerve block for TKA patients.