Peri-operative analgesic method does not affect rehabilitation outcomes following total knee arthroplasty

D. A. McDonald; A.H. Deakin; B.M. Ellis; Y. Robb; T.E. Howe; A.W.G. Kinninmonth; N.B. Scott

doi:10.1302/0301-620X.98B9.36250

Peri-operative analgesic method does not affect rehabilitation outcomes following total knee arthroplasty

D. A. McDonald, A.H. Deakin, B.M. Ellis, Y. Robb, T.E. Howe, A.W.G. Kinninmonth, N.B. Scott

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Abstract

This non-blinded randomised controlled trial compared the effect of patient controlled epidural analgesia (PCEA) versus local infiltration analgesia (LIA) within an established Enhanced Recovery Programme on attainment of discharge criteria and recovery at one year following surgery. The hypothesis was that LIA would increase the proportion of patients discharged from rehabilitation by post-operative day four but not affect outcomes at one year. 242 patients were
randomized with 109 patients receiving PCEA (mean age 66 SD (11)) and 113 receiving LIA (mean age 68 SD (10)). Patients were followed up at six weeks and one year. No difference was noted in the proportion of patients discharged from rehabilitation by post-operative day 4, PCEA =77% vs. LIA =82% (p=0.33) or mean length of stay (both 4 days, p=0.540). No difference was observed in day of first mobilisation (p= 0.013) or pain scores (P=0.278). At one year follow up
there were no differences in Oxford Knee Scores (both 41, p=0.915) or complication rates (two vs. six, p=0.281). Both techniques provided adequate pain relief, enabled early ambulation and accelerated rehabilitation and continued improvement in functional and patient reported outcomes up to one year following surgery. PCEA and LIA enable equitable clinical outcomes
following TKA.

Original language	English
Pages (from-to)	89-96
Number of pages	8
Journal	Bone and Joint Journal
Volume	98
Issue number	B11
Early online date	1 Sep 2016
DOIs	https://doi.org/10.1302/0301-620X.98B9.36250
Publication status	Published - Sep 2016

Keywords

analgesia
surgery
total knee arthroplasty
rehabilitation

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10.1302/0301-620X.98B9.36250

McDonald, D.A. et al (2016) Bone and Joint journal article
This is the accepted author manuscript of an article published in: Bone Joint J 2016;98-B1189–96. The final publisher version of this article is available at: https://doi.org/10.1302/0301-620X.98B9.36250 ©2016 The British Editorial Society of Bone & Joint Surgery.
Accepted author manuscript, 546 KB

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McDonald, D. A., Deakin, A. H., Ellis, B. M., Robb, Y., Howe, T. E., Kinninmonth, A. W. G., & Scott, N. B. (2016). Peri-operative analgesic method does not affect rehabilitation outcomes following total knee arthroplasty. Bone and Joint Journal, 98(B11), 89-96. https://doi.org/10.1302/0301-620X.98B9.36250

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abstract = "This non-blinded randomised controlled trial compared the effect of patient controlled epidural analgesia (PCEA) versus local infiltration analgesia (LIA) within an established Enhanced Recovery Programme on attainment of discharge criteria and recovery at one year following surgery. The hypothesis was that LIA would increase the proportion of patients discharged from rehabilitation by post-operative day four but not affect outcomes at one year. 242 patients wererandomized with 109 patients receiving PCEA (mean age 66 SD (11)) and 113 receiving LIA (mean age 68 SD (10)). Patients were followed up at six weeks and one year. No difference was noted in the proportion of patients discharged from rehabilitation by post-operative day 4, PCEA =77% vs. LIA =82% (p=0.33) or mean length of stay (both 4 days, p=0.540). No difference was observed in day of first mobilisation (p= 0.013) or pain scores (P=0.278). At one year follow upthere were no differences in Oxford Knee Scores (both 41, p=0.915) or complication rates (two vs. six, p=0.281). Both techniques provided adequate pain relief, enabled early ambulation and accelerated rehabilitation and continued improvement in functional and patient reported outcomes up to one year following surgery. PCEA and LIA enable equitable clinical outcomesfollowing TKA.",

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AU - Howe, T.E.

AU - Kinninmonth, A.W.G.

AU - Scott, N.B.

N1 - Acceptance in SAN Online pub: 1/9/16 AAM: minor differences between VoR and AAM eg. title difference made by editors. Catalogued according to AAM - ET Record was set to campus visibility - changed to public Funding: no funder note Exception email in SAN ^Exception valid (library exception review, October 2018)

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N2 - This non-blinded randomised controlled trial compared the effect of patient controlled epidural analgesia (PCEA) versus local infiltration analgesia (LIA) within an established Enhanced Recovery Programme on attainment of discharge criteria and recovery at one year following surgery. The hypothesis was that LIA would increase the proportion of patients discharged from rehabilitation by post-operative day four but not affect outcomes at one year. 242 patients wererandomized with 109 patients receiving PCEA (mean age 66 SD (11)) and 113 receiving LIA (mean age 68 SD (10)). Patients were followed up at six weeks and one year. No difference was noted in the proportion of patients discharged from rehabilitation by post-operative day 4, PCEA =77% vs. LIA =82% (p=0.33) or mean length of stay (both 4 days, p=0.540). No difference was observed in day of first mobilisation (p= 0.013) or pain scores (P=0.278). At one year follow upthere were no differences in Oxford Knee Scores (both 41, p=0.915) or complication rates (two vs. six, p=0.281). Both techniques provided adequate pain relief, enabled early ambulation and accelerated rehabilitation and continued improvement in functional and patient reported outcomes up to one year following surgery. PCEA and LIA enable equitable clinical outcomesfollowing TKA.

AB - This non-blinded randomised controlled trial compared the effect of patient controlled epidural analgesia (PCEA) versus local infiltration analgesia (LIA) within an established Enhanced Recovery Programme on attainment of discharge criteria and recovery at one year following surgery. The hypothesis was that LIA would increase the proportion of patients discharged from rehabilitation by post-operative day four but not affect outcomes at one year. 242 patients wererandomized with 109 patients receiving PCEA (mean age 66 SD (11)) and 113 receiving LIA (mean age 68 SD (10)). Patients were followed up at six weeks and one year. No difference was noted in the proportion of patients discharged from rehabilitation by post-operative day 4, PCEA =77% vs. LIA =82% (p=0.33) or mean length of stay (both 4 days, p=0.540). No difference was observed in day of first mobilisation (p= 0.013) or pain scores (P=0.278). At one year follow upthere were no differences in Oxford Knee Scores (both 41, p=0.915) or complication rates (two vs. six, p=0.281). Both techniques provided adequate pain relief, enabled early ambulation and accelerated rehabilitation and continued improvement in functional and patient reported outcomes up to one year following surgery. PCEA and LIA enable equitable clinical outcomesfollowing TKA.

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