Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Surgery

Supervisor

Dr. James Howard

2nd Supervisor

Dr. Sugantha Ganapathy

Co-Supervisor

3rd Supervisor

Dr. Edward Vasarhelyi

Co-Supervisor

Abstract

Regional anaesthetic techniques for the management of post-operative pain following total knee arthroplasty (TKA) are becoming increasingly popular. The purpose of this randomized control trial was to assess whether periarticular infiltration and infusion (LIA and infusion) had a comparable time-to-discharge and analgesic quality to a motor-sparing nerve block (MSNB) technique in patients who have undergone TKA. The study arms included continuous MSNB (n=35, control) and LIA and infusion (n=35, experimental). Continuous anaesthetic infusion of 0.2% Ropivacaine was delivered at a rate of 8ml/hr post-operatively. The primary outcome was time to discharge. Secondary objectives included pain scores at rest and activity, narcotic consumption, patient satisfaction and functional outcomes. Preliminary analysis of 54 patients (MSNB n=29, LIA and infusion n=25) was performed. No significant differences in outcome measures were demonstrated between groups. Based on these early findings, LIA and infusion provides similar clinical and functional outcomes to MSNB following primary TKA.

Summary for Lay Audience

Total knee replacement continues to become a more common surgical treatment option for knee arthritis in the Canadian population. Following surgery, a common complaint from patients is pain, which can inhibit their ability to mobilise early and delay discharge from hospital. Many pain options for pain control are available, each possessing their own benefits, but also potential risks. One promising option has been the use of local anaesthetic delivered around a nerve or the surgical site to decrease pain peripherally. This randomised trail assessed two pain control options using local anaesthetic that was constantly delivered either around a nerve or the surgical site to prolong the duration of pain control. These two groups were a motor-sparing nerve block (control group) and a novel periarticular infusion system (experimental group) that was placed in the tissue surrounding the knee joint. We compared the time to discharge, pain scores during rest and activity, narcotic medication consumption, and patient reported outcomes to assess if our experimental group produced similar outcomes to a proven peripheral nerve block following total knee replacement. This study’s purpose was to explore a continuous regional anaesthetic technique that was provided by a surgeon to circumvent factors such as resource constraints that prohibit the widespread use of peripheral nerve blocks in community centres for pain control following total knee replacement.

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