• M Antoni, J-Y Jenny, and E Noll.
• Hôpitaux Universitaires de Strasbourg, Service de Chirurgie Orthopédique et Traumatologique, Centre de Chirurgie Orthopédique et de la Main, 10, avenue Bauymann, 67400 Illkirch-Graffenstaden, France.
• Orthop Traumatol Sur. 2014 May 1;100(3):313-6.

IntroductionThe goal of this retrospective study was to compare pain control following total knee arthroplasty (TKA) on a perioperative protocol of local anesthesia (LA) versus the more classical femoral nerve block (FNB) technique.HypothesisFitness for discharge would be achieved earlier using the LA protocol.MaterialsNinety-eight consecutive TKA patients operated on by a single surgeon were included with no selection criteria. In the study group (49 patients), 200 mL ropivacaine 5% was injected into the surgical wound and an intra-articular catheter was fitted to provide continuous infusion of 20 mL/h ropivacaine for 24h. The control group (49 patients) received ropivacaine FNB. Discharge fitness (independent walking, knee flexion>90°, quadricipital control, pain on VAS≤3) and hospital stay were assessed.ResultsDischarge fitness was achieved significantly earlier in the study group (4.2±2.6 versus 6.7±3.2 days; P=0.0003), with significantly shorter mean hospital stay (6.1±3.4 versus 8.8±3.5 days; P=0.0002). The complications rate did not differ between study and control groups.DiscussionAlthough retrospective, this study indicates that the LA protocol improves management of post-TKA pain and accelerates rehabilitation, thereby, reducing hospital stay. The acceleration effect may be due to the absence of quadriceps inhibition.Level Of EvidenceLevel III - Case control study.Copyright © 2014 Elsevier Masson SAS. All rights reserved.

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