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Epidural catheter compared with local infiltration analgesia for postoperative pain relief in total knee replacement

Mohammadreza Minator Sajjadi, Mohammadreza Moshari, Mohammad Ali Okhovatpour, Reza Zandi, Keyvan Jalali





Background: This study compares the effects of epidural analgesia with infiltration analgesia in postoperative pain control for total knee arthroplasty.

Materials and methods: 47 females and 13 males with an average age of 65.7 years were randomly allocated into epidural (EA; n=30) and local infiltration anesthesia (LIA; n=30) groups. All patients received spinal anesthesia and were inserted epidural catheter. In LIA group, 50mL of a mixture, containing bupivacaine, ketorolac, morphine sulfate, and epinephrine was injected in to periarticular tissue and in EA group normal saline was injected. In the EA group, after surgery, an epidural catheter was attached to the patient-controlled analgesia (PCA) infusion pump with 25cc bupivacaine diluted in 75mL of normal saline but in LIA group, the PCA pump of the epidural catheter contained 100cc of normal saline, and the pump was blocked.

Results: The difference in demographic data was not significant between the groups. The mean VAS score (Pain) of EA group was significantly higher than LIA group until 12 hours after surgery, At 24 hours, there was no significant difference between two groups, and Pain of EA group was significantly lower than LIA group at 48 hours after the surgery. Dranage volume and hemoglobin drops were lower in LIA group. Knee range of motion in the LIA group was not superior to that of the EA group two weeks after surgery. The patients’ ability to perform active straight leg raise had no significant difference between two groups one day after the surgery.

Conclusion: local infiltration analgesia is better than epidural for postoperative pain control at first 12 hours. However, epidural analgesia can control postoperative pain more effectively at 48 hours after surgery. There was no significantly difference between two groups regard to patients ability to perform straight leg rising and Knee range of motion was similar in two groups.


Epidural catheter; Local infiltration anesthesia; Total knee replacement; Analgesia; spinal anesthesia; Pain management


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DOI: https://doi.org/10.22037/jcma.v4i4.29109


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