Optimizing Pain and Rehabilitation After Knee Arthroplasty: A Two-Center, Randomized Trial

Area of Science:

• Orthopedic Surgery
• Pain Management
• Anesthesiology

Background:

• Knee arthroplasty (TKA) necessitates effective postoperative pain management for optimal recovery.
• Various analgesia techniques, including continuous femoral nerve block (cFNB), single femoral nerve block (sFNB), and local infiltration analgesia (LIA), are employed to manage TKA pain.
• Comparative studies are essential to determine the most effective analgesic strategy for TKA patients.

Purpose of the Study:

• To compare the analgesic and functional outcomes of cFNB, sFNB, and LIA following primary tricompartmental TKA.
• To evaluate the efficacy of different nerve block and analgesia techniques in managing postoperative pain after knee replacement surgery.

Main Methods:

• A randomized trial involving 120 patients undergoing primary TKA.
• Patients were assigned to receive either cFNB, sFNB, or LIA for postoperative analgesia, alongside a standardized multimodal regimen.
• Pain scores (Numeric Rating Scale), opioid consumption, and functional outcomes were assessed, with blinding of participants and personnel.

Main Results:

• No statistically significant differences in pain during physiotherapy on postoperative day 2 were observed between cFNB, sFNB, and LIA groups.
• While the overall analysis for the primary outcome was significant, pairwise comparisons did not reveal significant differences between the treatment arms.
• cFNB and LIA demonstrated superiority over sFNB for early pain management (postoperative day 1) outcomes.

Conclusions:

• No clinically significant differences exist between cFNB, LIA, and sFNB for pain management on postoperative day 2 after TKA.
• cFNB and LIA show advantages over sFNB in providing early postoperative pain relief.
• The study highlights comparable efficacy for established nerve block and analgesia techniques in the medium term after knee arthroplasty.