Periarticular injection superior to epidural analgesia in TKA

(HealthDay)—For patients undergoing total knee arthroplasty, periarticular injection is superior to epidural analgesia for pain control, according to a study published in the Sept. 3 issue of The Journal of Bone & Joint Surgery.

Sachiyuki Tsukada, M.D., from Nekoyama Miyao Hospital in Niigata, Japan, and colleagues conducted a prospective, randomized controlled trial involving 111 patients scheduled for unilateral total knee arthroplasty to compare the clinical efficacies of epidural analgesia and periarticular injection. All patients were managed with spinal anesthesia and were treated with identical surgical techniques and postoperative medication protocols.

The researchers found that the periarticular injection group had a significantly lower area under the curve for pain score at rest in the intention-to-treat analysis (P = 0.0059). The mean knee flexion angle was small, but significantly better at postoperative days one and two in the periarticular injection group versus the epidural analgesia group (64.2 versus 54.6 degrees [P = 0.0072] and 70.3 versus 64.6 degrees [P = 0.021], respectively). The periarticular group experienced significantly lower incidence of nausea at postoperative day one (4.0 versus 44.3 percent; P < 0.001). In the periarticular injection group, transient peroneal nerve palsy was frequently observed (12.0 versus 1.6 percent; P = 0.026).

"Compared with epidural analgesia, periarticular injection offers better postoperative pain relief, earlier recovery of knee flexion angle, and lower incidence of nausea," the authors write.