Pain Management in Total Knee Arthroplasty: A Comparison of Periarticular Infiltration with Femoral and Sciatic Nerve Block

Background: The effect of periarticular infiltration (PAI) of Bupivacaine (Exparel®) with Marcaine® in the ipsilateral knee compared to femoral and sciatic nerve blocks (FSNB) in the contralateral knee in one-stage bilateral total knee arthroplasty (BTKA) has not yet been widely reported in the literature. This study compared the effect of PAI in the ipsilateral knee and FSNB in the contralateral knee on the postoperative pain and quadriceps function following a one-stage BTKA. Methods: Fourteen patients who underwent one-stage BTKA for osteoarthritis were included in this prospective study. The surgical protocol was similar for all patients except for one randomized intervention: PAI in the ipsilateral knee (PAI knees) and FSNB in the contralateral knee (FSNB knees). The postoperative pain management protocol was the same for all patients. The postoperative pain was measured with the visual analogue scale (VAS) pain score on postoperative days (POD) 1, 2 and 3. The quadriceps power was clinically assessed in PAI and FSNB knees on POD 1, 2 and 3. Results: On POD 1, 2 and 3, the VAS pain scores were comparable between the PAI knees and the FSNB knees (p value 0.61, 0.83 and 0.92 respectively). The quadriceps power was significantly lower in the FSNB knees compared to PAI knees on POD 1 (p = 0.012). No significant difference in the quadriceps power was noted between the PAI knees and the FSNB knees on POD 2 (p = 0.257) and POD 3 (p = 0.072). Conclusion: During one-stage BTKA, administration of PAI for the ipsilateral knee and FSNB for the contralateral knee provides clinically similar postoperative pain relief on POD 1, 2 and 3. FSNB knees had significantly lower quadriceps power on POD1 compared to PAI knees. However, on POD2 and 3 no such significant difference in the quadriceps power was noted clinically between the PAI and FSNB knees. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.