Periarticular Infiltration Compared to Single Femoral Nerve Block in Total Knee Arthroplasty: A Prospective Randomized Study

Lopes Júnior, Osmar Valadão; Viana, Juliano Munhoz; Carvalho, Juliany Aguirre de; Folle, Bruno Lunardi; Kuhn, Vinícius Canelo; Saggin, Paulo Renato Fernandes

doi:10.1055/s-0044-1785449

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Original Article • Rev bras ortop 59 (2) • 2024 • https://doi.org/10.1055/s-0044-1785449 copy

Periarticular Infiltration Compared to Single Femoral Nerve Block in Total Knee Arthroplasty: A Prospective Randomized Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To compare patients undergoing total knee arthroplasty (TKA) under spinal anesthesia and single femoral nerve block (FNB) with subjects undergoing TKA under spinal anesthesia and periarticular infiltration (PAI).

Materials and Methods

A total of 100 patients undergoing primary TKA were randomized into two groups. Group 1 included patients undergoing surgery under FNB associated with spinal anesthesia, while group 2 included patients undergoing TKA under IPA and spinal anesthesia. The assessment of these subjects in the early postoperative period included pain, active flexion, active extension, elevation of the extended limb, and morphine use.

Results

There was no significant difference in the types of analgesia concerning pain, the elevation of the extended limb, and morphine use. Active flexion and extension were better in the PAI group (p = 0.04 and p = 0.02 respectively).

Conclusion

We conclude that the techniques are similar regarding pain control, limb elevation, and morphine use. The use of IPA provided better active flexion and extension during the hospital stay compared to single FNB in patients undergoing TKA.

Keywords
analgesia; anesthetics, local; arthroplasty, replacement, knee; nerve block; infiltration; femoral nerve

Variables		Total sample (n = 100)	FNB group (n = 50)	PAI group (n = 50)	p
Age (years): mean ± SD		67.9 ± 7.7	68.1 ± 7.5	67.7 ± 7.9	0.400^* * Student's t-test;
Sex: n (%)					1.000^ Pearson Chi-squared test.
	Male	23 (23.0)	11 (22.0)	12 (24.0)
	Female	77 (77.0)	39 (78.0)	38 (76.0)
Location: n (%)					1.000^ Pearson Chi-squared test.
	Headquarters	69 (69.0)	35 (70.0)	34 (68.0)
	Branch	31 (31.0)	15 (30.0)	16 (32.0)
Side: n (%)					0.316^ Pearson Chi-squared test.
	Right	54 (54.0)	30 (60.0)	24 (48.0)
	Left	46 (46.0)	20 (40.0)	26 (52.0)
Hospitalization time (days): mean ± SD		4.28 ± 0.52	4.39 ± 0.53	4.18 ± 0.48	0.208^* * Student's t-test;

Variables		FNB group (n = 50)	PAI group (n = 50)	p ^# # comparison between the groups using the LSD test and the generalized estimating equations (GEE) model.
Pain (VAS): mean ± SD
	1^st day PO	4.94 ± 2.25^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	4.94 ± 2.40^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	1.000
	2^nd day PO	4.86 ± 2.22^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	4.32 ± 1.98^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.195
	3^rd day PO	2.84 ± 1.80^a a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	2.88 ± 1.99^a a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.915
	Difference between the 1^st and 3^rd days PO (95%CI)	−2.10 (−2.68 to −1.52)	−2.06 (−2.69 to −1.43)	0.199^ group versus time interaction effect;
Active ROM in flexion: mean ± SD
	1^st day PO	42.7 ± 22.4^a a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	47.9 ± 22.9^a a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.248
	2^nd day PO	56.2 ± 18.8^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	63.4 ± 17.4^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.046
	3^rd day PO	77.8 ± 15.1^c a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	83.0 ± 11.2^c a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.047
	Difference between the 1^st and 3^rd days PO (95%CI)	35.1 (29.5 to 40.6)	35.1 (29.8 to 40.4)	0.571^ group versus time interaction effect;
Active ROM in extension: mean ± SD
	1^st day PO	1.30 ± 2.44^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	1.22 ± 2.17^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.869
	2^nd day PO	1.10 ± 2.32^ab a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.50 ± 1.52^a a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.122
	3^rd day PO	0.80 ± 1.85^a a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.80 ± 1.85^ab a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	1.000
	Difference between the 1^st and 2^nd days PO (95%CI)	−0.20 (−0.47 to 0.07)	−0.72 (−1.21 to −0.24)	0.025^ group versus time interaction effect;
	Difference between the 2^nd and 3^rd days PO (95%CI)	−0.30 (−0.73 to 0.13)	0.30 (−0.13 to 0.73)
	Difference between the 1^st and 3^rd days PO (95%CI)	−0.50 (−1.00 to −0.00)	−0.42 (−1.10 to 0.25)
Elevation (cm): mean ± SD
	1^st day PO	16.9 ± 21.8^a a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	22.7 ± 25.4^a a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.222
	2^nd day PO	26.6 ± 24.2^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	35.2 ± 25.0^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.078
	3^rd day PO	39.4 ± 23.6^c a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	43.3 ± 23.7^c a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.401
	Difference between the 1^st and 3^rd days PO (95%CI)	22.5 (18.1 to 26.9)	20.7 (15.4 to 26.0)	0.160^ group versus time interaction effect;
Morphine use (mg)
	1^st day PO	3.62 ± 3.95^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	4.20 ± 4.51^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.489
	2^nd day PO	2.71 ± 3.71^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	2.95 ± 3.08^b a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.722
	3^rd day PO	0.59 ± 1.39^a a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	1.16 ± 2.87^a a,b,c Intragroup comparison: equal letters denote lack of difference per the least significant difference (LSD) test at 5% significance;	0.201
	Difference between the 1^st and 3^rd days PO (95%CI)	−3.03 (−4.02 to −2.04)	−3.04 (−4.48 to −1.60)	0.880^ group versus time interaction effect;

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E-mail: rbo@sbot.org.br

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[1] Address for correspondence Osmar Valadão Lopes Júnior, M.D., Departamento de Ortopedia e Traumatologia, Hospital São Vicente de Paulo, Universidade Federal da Fronteira Sul, Rua Uruguai 2.050, Passo Fundo, RS, zip code: 99010-112, Brazil (e-mail: osmarlopesjr@gmail.com).