An anatomic study of local infiltration analgesia in total knee arthroplasty

M. Quinn, A. H. Deakin, D. A. McDonald, I. K. T. Cunningham, A. P. Payne, F. Picard

Research output: Contribution to journalArticle

Abstract

Background: Local infiltration analgesia (LIA) is a relatively novel technique developed for effective pain control following total knee arthroplasty (TKA), reducing requirements for epidural or parenteral postoperative analgesia. This study investigated the anatomical spread of an LIA used in TKA to identify the nerve structures reached by the injected fluid.
Methods: Six fresh-frozen cadaveric lower limbs were injected according to a standardised LIA technique with a solution of latex and India ink to enable visualisation. Wounds were closed and limbs placed flat in a freezer at - 20 °C for two weeks. Limbs were then either sliced or dissected to identify solution locations.
Results: Solution was found from the proximal thigh to the middle of the lower leg. The main areas of concentration were the popliteal fossa, the anterior aspect of the femur and the subcutaneous tissue of the anterior aspect of the knee. There was less solution in the lower popliteal fossa. The solution was found to reach the majority of nerves, with good infiltration of nerves supplying the knee.
Conclusions: These results support the positive clinical outcomes with this LIA technique. However, the lack of infiltration into the lower popliteal fossa suggests more fluid or a different injection point could be used. The solution reaching the extensor muscles of the lower leg is likely to have no beneficial analgesic effect for a TKA patient. The LIA technique is already used in clinical practice following total knee arthroplasty. Results from this study show there may be scope to optimise the injection sites in LIA technique.
Original languageEnglish
Pages (from-to)319-323
Number of pages5
JournalKnee
Volume20
Issue number5
Early online date15 Jul 2013
DOIs
Publication statusPublished - Oct 2013

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Knee Replacement Arthroplasties
Analgesia
Leg
Knee
Extremities
Injections
Subcutaneous Tissue
Latex
Thigh
Femur
Analgesics
Lower Extremity
Pain
Muscles
Wounds and Injuries

Keywords

  • total Knee arthroplasty
  • local infiltration analgesia
  • cadaveric
  • enhanced recover programmes

Cite this

Quinn, M., Deakin, A. H., McDonald, D. A., Cunningham, I. K. T., Payne, A. P., & Picard, F. (2013). An anatomic study of local infiltration analgesia in total knee arthroplasty. Knee, 20(5), 319-323. https://doi.org/10.1016/j.knee.2013.06.008
Quinn, M. ; Deakin, A. H. ; McDonald, D. A. ; Cunningham, I. K. T. ; Payne, A. P. ; Picard, F. / An anatomic study of local infiltration analgesia in total knee arthroplasty. In: Knee. 2013 ; Vol. 20, No. 5. pp. 319-323.
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Quinn, M, Deakin, AH, McDonald, DA, Cunningham, IKT, Payne, AP & Picard, F 2013, 'An anatomic study of local infiltration analgesia in total knee arthroplasty', Knee, vol. 20, no. 5, pp. 319-323. https://doi.org/10.1016/j.knee.2013.06.008

An anatomic study of local infiltration analgesia in total knee arthroplasty. / Quinn, M.; Deakin, A. H. ; McDonald, D. A.; Cunningham, I. K. T.; Payne, A. P.; Picard, F.

In: Knee, Vol. 20, No. 5, 10.2013, p. 319-323.

Research output: Contribution to journalArticle

TY - JOUR

T1 - An anatomic study of local infiltration analgesia in total knee arthroplasty

AU - Quinn, M.

AU - Deakin, A. H.

AU - McDonald, D. A.

AU - Cunningham, I. K. T.

AU - Payne, A. P.

AU - Picard, F.

PY - 2013/10

Y1 - 2013/10

N2 - Background: Local infiltration analgesia (LIA) is a relatively novel technique developed for effective pain control following total knee arthroplasty (TKA), reducing requirements for epidural or parenteral postoperative analgesia. This study investigated the anatomical spread of an LIA used in TKA to identify the nerve structures reached by the injected fluid.Methods: Six fresh-frozen cadaveric lower limbs were injected according to a standardised LIA technique with a solution of latex and India ink to enable visualisation. Wounds were closed and limbs placed flat in a freezer at - 20 °C for two weeks. Limbs were then either sliced or dissected to identify solution locations.Results: Solution was found from the proximal thigh to the middle of the lower leg. The main areas of concentration were the popliteal fossa, the anterior aspect of the femur and the subcutaneous tissue of the anterior aspect of the knee. There was less solution in the lower popliteal fossa. The solution was found to reach the majority of nerves, with good infiltration of nerves supplying the knee.Conclusions: These results support the positive clinical outcomes with this LIA technique. However, the lack of infiltration into the lower popliteal fossa suggests more fluid or a different injection point could be used. The solution reaching the extensor muscles of the lower leg is likely to have no beneficial analgesic effect for a TKA patient. The LIA technique is already used in clinical practice following total knee arthroplasty. Results from this study show there may be scope to optimise the injection sites in LIA technique.

AB - Background: Local infiltration analgesia (LIA) is a relatively novel technique developed for effective pain control following total knee arthroplasty (TKA), reducing requirements for epidural or parenteral postoperative analgesia. This study investigated the anatomical spread of an LIA used in TKA to identify the nerve structures reached by the injected fluid.Methods: Six fresh-frozen cadaveric lower limbs were injected according to a standardised LIA technique with a solution of latex and India ink to enable visualisation. Wounds were closed and limbs placed flat in a freezer at - 20 °C for two weeks. Limbs were then either sliced or dissected to identify solution locations.Results: Solution was found from the proximal thigh to the middle of the lower leg. The main areas of concentration were the popliteal fossa, the anterior aspect of the femur and the subcutaneous tissue of the anterior aspect of the knee. There was less solution in the lower popliteal fossa. The solution was found to reach the majority of nerves, with good infiltration of nerves supplying the knee.Conclusions: These results support the positive clinical outcomes with this LIA technique. However, the lack of infiltration into the lower popliteal fossa suggests more fluid or a different injection point could be used. The solution reaching the extensor muscles of the lower leg is likely to have no beneficial analgesic effect for a TKA patient. The LIA technique is already used in clinical practice following total knee arthroplasty. Results from this study show there may be scope to optimise the injection sites in LIA technique.

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KW - local infiltration analgesia

KW - cadaveric

KW - enhanced recover programmes

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DO - 10.1016/j.knee.2013.06.008

M3 - Article

VL - 20

SP - 319

EP - 323

JO - Knee

JF - Knee

SN - 0968-0160

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ER -