Postoperative analgesia after total knee arthroplasty. Comparing efficiency of three methods: continuous iliac fascia block, continuous epidural analgesia and conventional intramuscular pethidine administration.

ABSTRACT

In this study we compared the efficacy of three methods of analgesia following total knee arthroplasty (TKA). Fifty-seven patients (n=57), with mean age 70 + 5 and physical status ΑSA I-III, were scheduled for TKA and were randomly allocated in into three groups. Group A patients (n=19) received analgesia by continuous iliac fascia block (CIFB), group B patients (n=19) received continuous epidural analgesia (CEA) and group C patients (n= 19) received intramuscular pethidine at regular time intervals. During the first forty-eight hours after the operation (at 2, 4, 12, 24 and 48 hours) the following parameters were recorded and analysed: severity of pain, supplementary analgesics required and complications occurring for every group of patients. Group A and B patients had significantly better pain relief, compared to group C patients. The need for additional drugs was not statistically significant between groups A and B. More group C patients needed supplementary analgesics, in comparison with groups A and B. Group A had significantly fewer complications, when compared to groups B and C. As a conclusion, the methods of CIFB and CEA following TKA provide significantly better pain relief, compared to intramuscular pethidine administration. CIFB seems to be as treatment of choice for providing the most effective analgesia after TKA, since it provides equally effective analgesia as CEA, has the fewest complications and is the simplest of the three methods, not requiring either nerve stimulation or induction of paresthesia.