Is wound catheter needed for local high-volume infiltration anesthesia in total knee replacement?

BACKGROUND: The use of local high-volume infiltration anesthesia (LHVIA) is becoming increasingly popular for postoperative analgesia in total knee arthroplasty (TKA). However, one of the elements of the technique is the use of an intraarticular or wound catheter to prolong the analgesic effect.

AIM: Therefore, the investigation aimed to estimate wound catheter use as a component of LHVIA in TKA.

MATERIALS AND METHODS: The study included 102 patients who underwent primary TKA for stage 3 gonarthrosis under spinal anesthesia with intravenous sedation. Two groups were formed by envelope randomization: the LHVIAc group (n=51) in which the wound catheter was placed at the end of the operation and followed by the infusion of the local anesthetic solution for 24 h; and the LHVIA group (n=51) in which the patients were treated without a catheter.

RESULTS: The groups were comparable in terms of sex, age, and the nature of the pathology. The LHVIAc group showed a significantly decreased severity of pain in 4–6 h after surgery, both at rest and during flexion of the knee (p=0.001 and p=0.003). On postoperative day 1, the use of the wound catheter contributed to a significantly decreased severity of pain syndrome when flexing the knee (p=0.002). No infectious complications or significant adverse reactions were recorded in the groups.

CONCLUSION: 1) LHVIA is an effective method of postoperative analgesia in TKA; 2) the use of the catheter in the early postoperative period increased the analgesic effect of LHVIA without increasing the frequency of infectious and other complications; 3) the use of the wound catheter reduced the severity of pain syndrome in postoperative day 1 during activation, which facilitates postoperative rehabilitation of patients with TKA.