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A comparative study of post-operative analgesia after unilateral total knee replacement: local wound infiltration versus epidural anesthesia

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Viveka Bala, Devnil Pathak , Dr. Abhinav srivastav
» doi: 10.31838/ecb/2023.12.si6.077


To compare the post-operative analgesic efficacy of Local Infiltration Analgesia (LIA) technique overEpidural Analgesia (EA) technique in patients undergoing unilateral total knee replacements. Patients and Methods: After prior approval of the institutional ethical committee sixty patients who were posted for unilateral total knee replacement were included in this study. This prospective randomized controlled study compared analgesic efficacy in postoperative patients (initial 48 h) of total knee replacement where one group of patients are given local analgesia and the other group are given epidural analgesia. All patients received spinal anesthesia and were inserted epidural catheter The patients were randomized into two groups by randomization. In LIA group 50mL of a mixture, containing bupivacaine, ketorolac, and epinephrine was injected in to periarticular tissue and in EA group ropivacaine was injected.In the EA group, after surgery, an epidural catheter ropivacaine top ups were given but in LIA group, the epidural catheter normal saline was given Results: The pain relief on the day of surgery (day 1) was significantly better in patients who received pericapsular injection as compared to those who used the epidural injection for postoperative pain relief. At 24 hours, there was no significant difference between two groups, and pain of EA group was significantly lower than LIA group at 48 hours after the surgery. Drainage volume and hemoglobin drops were lower in LIA group. Conclusion: Local infiltration analgesia was better than epidural for postoperative pain control at first 12 hours. However, epidural analgesia could control postoperative pain more effectively at 48 hours after surgery. Patients who received epidural infusion for postoperative pain control required more medications assupplements, as evidenced by higher incidence of bolus injections/increased infusion rates/tramadol injections

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