ACUTE POST OPERATIVE PAIN MANAGEMENT IN TOTAL KNEE ARTHROPLASTY; A COMPARATIVE STUDY BETWEEN PCA AND PCA WITH LOCAL NERVE BLOCKS.

Abstract

Introduction: The Royal College of anaesthetists in 2000 issued its recommendations about raising the standard in postoperative pain management.

It recommended that 100% patients should be satisfied with the management of their pain and any side effects of analgesic treatment.

We conducted this prospective study to compare effectiveness of combining local nerve blocks with PCA (patient controlled analgesia) morphine to PCA morphine only in controlling acute post operative pain among total knee arthroplasty patients.

Patients and Methods: Prospective study from January 2002 till November 2003.

It involves 50 Patients underwent total knee replacement.

Average patient age 71y (range 53–83y)

Patients divided into two groups: (A) – PCA (patient controlled analgesia) Morphine only and (B) – PCA

Morphine + local nerve Blocks

Data collected:

Pain score at 1,3,6,12,24 hrs after operation, Morphine used, Supplementary analgesia, Side effects (vomiting score), Patients satisfaction, Patients’ knee joint early range of movement and Patients average period of hospital stay.

Results: Optimum pain control was 94% in group B compared with 78% in group A

Side effects was seen in 30% in group B compared to 45% in group A

There was no difference in the knee joint early range of movement

There was no difference in the patients’ average period of hospital stay.

Conclusion: This study concludes that the pain relief, morphine usage, side effects and patient satisfaction are much better with PCA when combined with local nerve blocks than with PCA alone.

We recommend that more total knee arthroplasty patients should be offered local nerve blocks in addition to their standard anaesthesia.