The use of epidural bupivacaine following total knee arthroplasty

Pain relief and maximization of knee joint range of motion (ROM) are the two major goals in the postoperative management of the total knee arthroplasty (TKA) patient. Epidural bupivacaine infusions have been reported to be safe and effective for pain control in obstetric anesthesia, chronic pain management, and postoperative pain relief. The purpose of this study was to evaluate the effect of continuous epidural bupivacaine on postoperative pain and progressive knee ROM as well as to record the incidence of urinary retention and other side effects or complications. Continuous epidural bupivacaine infusion was found to provide safe, effective analgesia for TKA patients in the immediate postoperative period. Excellent pain relief with reduced narcotic requirements was observed in the patients as compared to intramuscular narcotic analgesia. No complications occurred and serum bupivacaine levels remained well below toxic levels. Short term clinical orthopaedic outcome was improved, and patient, surgeon, and nurse acceptance of the technique was excellent.