Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

The postoperative analgesic potential of periarticular anesthetic infiltration (PAI) after TKA is unclear as are the complications of continuous femoral nerve block on quadriceps function. We asked (1) whether PAI provides equal or improved postoperative pain control in comparison to a femoral nerve block in patients who have undergone TKA; and (2) if so, whether PAI improves early postoperative quadriceps control and facilitates rehabilitation. We randomized 60 patients to receive either PAI or femoral nerve block. During the first 5 days after TKA, we compared narcotic consumption, pain control, quadriceps function, walking distance, knee ROM, capacity to perform a straight leg raise, and active knee extension. Medication-related side effects, complications, operating room time, and hospitalization duration were compared. Opioid consumption was lower in the PAI group during the first 8 postoperative hours (12.5 mg versus 18.7 mg morphine), as was reported pain at rest (1.7 versus 3.5 on a 10-point VAS). Thereafter, narcotic consumption and reported pain were similar up to 120 hours. More subjects in the femoral nerve block group experienced quadriceps motor block (37% versus 0% in the PAI group). On Days 1 to 3, subjects in the PAI group experienced better capacity to perform the straight leg raise, active knee extension, and had longer walking distances. PAI provided pain control equivalent to that of a femoral nerve block while avoiding a motor block and its negative functional impacts. The data suggest it should be considered an alternative to a femoral nerve block. Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.