Efficacy of different multimodal analgesia techniques to prevent moderate to severe pain in primary total knee arthroplasty

Abstract Introduction: Osteoarthritis is one of the most prevalent diseases and the knee is the most affected joint in women over 70 years old. Primary total knee replacement is a definitive and cost effective treatment. The age group, the comorbidities, and the high incidence of postoperative moderate to severe pain are challen ging for anesthesia management. Objectives: To describe the efficacy of different multimodal analgesia techniques used in primary total knee replacement in terms of moderate to severe pain, during the first 48 postoperative hours. Materials and methods: Observational trial analyzing the medical records of 79 patients, focusing on the clinical, anesthetic, and analgesic characteristics over 10 months. The primary outcome was the incidence of moderate to severe immediate postoperative pain, after 24 and 48hours; the secondary outcome was compliance with the rehabilitation goals. Results: Regional anesthesia was used in 89% of the patients. Using the femoral perineural catheter in addition to single-dose sciatic nerve block (47%), the incidence of immediate moderate to severe postoperative pain and after 24 and 48hours was 5%, 16%, and 14%, respectively, while with single-dose regional anesthesia, the incidence was 43%, 34%, and 36%, respectively. The level of compliance with the rehabilitation goals was similar among the various analgesic techniques. Conclusions: Regional anesthesia was used in most cases, although in a heterogeneous manner. The femoral perineural catheter is associated with a lower incidence of postoperative moderate to severe pain, and the results are consistent with the literature reviewed.