Yoeri Bemelmans

Chapter 4 52 Figure 1. Mean experienced pain (vertical axis) before and after the first mobilization, during the first 48h, measured direct postoperative (post OR), and daily 8:00, 16:00 and on 22:00 h (horizontal axis) with use of a VAS pain score. Standard deviations (SD) are displayed with whiskers. 0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0 80,0 VAS PRE VAS post Post OK 16:00 22:00 8:00 16:00 22:00 8:00 16:00 22:00 Ropivacaine without adrenaline Ropivacaine with adrenaline Mobilization Day 0 Day 1 Day 2 VAS Pre S Post Post R Discussion The most important findings of the present study was that the ropivacaine and adrenaline LIAmixture was not clearly superior to LIA consisting only ropivacaine with respect to experienced pain before and after the first mobilization and during the first 48 h postoperative. In this study, both groups gave improved and comparable pain relief after TKA. These comparable results on pain relief could be explained by the fact that ropivacaine itself isa long-actinganalgesicwithvasoconstrictiveproperties toreduce local absorption [4, 5, 22, 24]. Poorly managed postoperative pain after TKA negatively influences early postoperative recovery [14] and discharge [8, 16, 17]. In this trial none of the patients had a delayed mobilization due to high pain intensity. Most of the delayed mobilization occurred in patients infiltrated with adrenaline including vasovagal syn-copes, major wound leakages and one patient did not had any sensibility in both legs due to delayed recovery from spinal anaesthesia. These patients had a delayed discharge, which was in line with the results of Husted et al. [15, 16] who found a relation between length of hospital stay and early mobilization. In this trial serious side effects were observed in both groups, which resulted in prolonged hos-pital stay and hospital readmissions.