The Analgesic Efficacy of Local Anaesthetic Wound Infiltration Versus Intrathecal Morphine for Total Knee Replacement

Phase 4 Unknown 42 enrolled Cork University Hospital

RandomizedParallel-groupSingle-blindTreatment

Summary

Total knee replacement (TKR) is associated postoperatively with considerable pain and analgesic requirement. Total knee replacement is routinely performed under spinal anaesthesia with intrathecal bupivacaine plus preservative free morphine. We hypothesize that infiltration of the surgical site with peri- and intraarticular levobupivacaine local anaesthetic would be an efficacious pain management technique and would not be inferior to intrathecal morphine for postoperative pain management. We further hypothesize that the use of this surgical site infiltration technique would decrease post-operative systemic opioid requirements as well as the side effects associated with intrathecal and systemic opioids.

Timeline

Start: 2010-08
Primary completion: 2011-06
Completion: 2011-06

Outcome

Met primary endpoint

paper VAS scores for pain at 24 h were lower in the intervention group than the control group at rest PMID 30640244 ↗

paper 16.43 (± 20.3) vs. 37.2 (± 33.6), (P = 0.029). PMID 30640244 ↗

paper VAS scores for pain at 24 h on movement were also lower in the intervention group vs. the control group; PMID 30640244 ↗

paper 39.1 (± 22.8) vs. 57.0 (± 30.9), (P = 0.037). PMID 30640244 ↗

Publications

McCarthy D, McNamara J, Galbraith J, Loughnane F, Shorten G, Iohom G. A comparison of the analgesic efficacy of local infiltration analgesia vs. intrathecal morphine after total knee replacement: A randomised controlled trial. Eur J Anaesthesiol. 2019 Apr;36(4):264-271. doi: 10.1097/EJA.0000000000000943.

Drugs

Evaluation	Drug	Modality	Dose	Route
Subject	Levobupivacaine	Other / unclassified	2 mg/kg	Other
Subject	Levobupivacaine	Other / unclassified	15 ml	Other
Subject	Morphine	Other / unclassified	0.3 mg	Intrathecal
Background	Bupivacaine	Other / unclassified	15 mg	Intrathecal
Background	Bupivacaine	Other / unclassified	17.5 mg	Intrathecal
Background	Epinephrine	Other / unclassified	0.5 mg	—

Indications

No indication recorded.