Efficacy of Multimodal Peri- and Intraarticular Drug Injections in Total Knee Arthroplasty

• Opioid Use [ Time Frame: 48 hours postoperative ] [ Designated as safety issue: No ]
  Morphine used by patient controlled analgesia. Amount of used morphine during the first 48 hours after surgery were documented in the CRF by the pain nurses.
• Time to Readiness for Discharge [ Time Frame: up to 10 days postoperative ] [ Designated as safety issue: No ]
  Each postoperative day, discharge readiness was assessed by an orthopaedic surgeon, a pain nurse, a ward nurse, and a physiotherapist according to the following criteria: no evidence for surgical complications, VAS pain at rest ≤30 mm which is controlled by oral analgesics, ability to eat and drink, ability to walk with elbow crutches, and ability to climb ≥8 stairs.

• Pain [ Time Frame: 48 hours postoperative ]
• time to discharge [ Time Frame: 10 days postoperative ]
• Knee injury and osteoarthritis score [ Time Frame: 3 month postoperative ]
• side effects and complications [ Time Frame: postoperative period ]

Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain, causing patient discomfort, mobilisation and hospital discharge.

The aim of this study is to:

1. Compare analgetic efficacy of to types of local infiltration analgesia in total knee arthroplasty.
2. Compare analgetic efficacy of local infiltration analgesia with continuous epidural analgesia.

Total knee arthroplasty (TKA) is increasingly common in the treatment of knee osteoarthritis. TKA is associated with moderate to severe postoperative pain, causing patient discomfort, mobilisation and hospital discharge.

Continuous epidural analgesia is often used for controlling pain after TKA. Recent studies describe a new method for pain control after total knee arthroplasty which consists of local infiltration with local anesthetics and adrenaline. This infiltrations can be combined with ketorolac and/or morphine. The aim of this study is to:

1. Compare analgetic efficacy of to types of local infiltration analgesia in total knee arthroplasty.
2. Compare analgetic efficacy of local infiltration analgesia with continuous epidural analgesia.

• Drug: ropivacaine
  intraoperative and 1. postoperative day
  Other Name: Naropin
• Drug: adrenaline
  intraoperative LIA (IV and IA) and continuous EDA
  Other Names:

  • Adrenalin
  • (epinephrine)
• Drug: ketorolac
  intraoperative and 1. postoperative day
  Other Name: Toradol
• Drug: morphine
  intraoperative
  Other Name: Morfin
• Drug: fentanyl
  continuous postoperatively
  Other Name: Fentanyl
• Drug: bupivacaine
  continuous postoperatively
  Other Name: Marcain

• Experimental: LIA IV
  Local infiltration analgesia with ropivacaine and adrenaline and intravenous ketorolac and morphine
  Interventions:

  • Drug: ropivacaine
  • Drug: adrenaline
  • Drug: ketorolac
  • Drug: morphine
• Experimental: LIA IA
  Local infiltration analgesia with ropivacaine, adrenaline and ketorolac and morphine
  Interventions:

  • Drug: ropivacaine
  • Drug: adrenaline
  • Drug: ketorolac
  • Drug: morphine
• Active Comparator: EDA
  standard continuous epidural analgesia
  Interventions:

  • Drug: adrenaline
  • Drug: fentanyl
  • Drug: bupivacaine

Inclusion Criteria:

• patients at least 18 years of age
• scheduled for elective total knee arthroplasty
• ASA I-III
• signed written informed consent

Exclusion Criteria:

• age < 18
• ASA > III
• moderate or severe cardiac disease, bronchial asthma
• allergy against ropivacaine, ketorolac or morphine
• analgetic abuse
• pregnancy or nursing women
• severe psychiatric disease
• moderate to severe dementia