Yoeri Bemelmans

Chapter 4 46 Abstract Purpose Local infiltration analgesia (LIA) is widely applied in patients undergoing total knee arthroplasty (TKA). In daily practice, adrenaline is added to the LIA mixture to achieve vasoconstriction. However, adrenaline has some possible negative side effects (e.g. tissue necro-sis). This trial investigated whether ropivacaine alone is at least as effective for postoperative pain relief after LIA. Methods Fifty patients scheduled for primary TKA were included in this prospective randomized, double-blind, controlled pilot study receiving high-volume (150 mL) single-shot intra-capsular LIA with ropivacaine (2 %) with (Ropi+) or without (Ropi−) adrenaline (0.01 %). All patients received the same pre-, peri- and postoperative care withmultimodal oral pain protocol. Postoperative painwas assessed before and after the first mobilization and during the first 48 h postoperative using the visual analogue scale (VAS). Secondary outcomes were rescue medication use, early mobilization, length of hospital stay, adverse events (AE’s) and readmission rates. Patient reported outcomes measures (PROMS); Oxford Knee Score and WOMAC, were obtained preoperative and 3 months postoperative. Results VAS scores were not significantly different before (n.s.) and after the first mobilization (n.s.), neither over the first 48 h postoperative (n.s.). Patients who needed rescue medication (n.s.), whomobilized <6 h postoperative (n.s.), who were discharged before postoperative day 3 (n.s.), AE’s and readmission rate (n.s.) were comparable between both groups. At 3-month follow-up, PROMS significantly improved within both groups. Conclusion To prevent possible negative side effects (e.g. tissue necrosis), adrenaline should be omitted from the LIAmixture. Single-shot LIA with ropivacaine alone results in clinical acceptable adequate pain control and can be used in daily TKA practice. Keywords Adrenaline; Epinephrine; Local infiltration analgesia; Painmanagement; Total knee arthroplasty; Early mobilization; Early discharge; Fast track