Influence of a Tourniquet on Opioid Consumption After Local Infiltration Analgesia for Total Knee Arthroplasty

Local infiltration analgesia (LIA) with ropivacaine is increasingly used to provide postoperative analgesia after total knee arthroplasty (TKA). TKA may be performed with or without the use of a tourniquet. The absence of local blood flow when infiltrating local anaesthesia below an inflated tourniquet may affect the rate of systemic absorption, and this may have an effect on the duration and intensity of analgesia as compared with LIA without the use of a tourniquet. The aim of the present study was to investigate the influence of tourniquet use during surgery on the time to first request (TTFR) of opioids and opioid consumption.

Two historical time-based cohorts (one with and one without tourniquet during surgery) of 300 patients underwent primary TKA under spinal anaesthesia and received LIA to provide postoperative analgesia. The cohorts were compared for TTFR of opioids and opioid consumption.

TTFR did not significantly differ between the tourniquet and non-tourniquet groups with a median (25^th-75^th percentile) of 240 (102-651) and 282 (100-720) min, respectively. The median (25^th-75^th percentile) oxycodone use was higher in the tourniquet group with 50 (20-90) versus 40 (10-77.5) mg (p=0.01).

There was no difference in the time to first opioid consumption, suggesting that the presence of an inflated tourniquet during local anaesthetic injection does not alter systemic absorption sufficiently to affect the duration of analgesia. However, the use of a tourniquet was associated with a higher opioid consumption, which is most likely caused by pain resulting from the tourniquet itself.