Comparison of local infiltration analgesia with single injection femoral nerve block in total knee arthroplasty.

The purpose of this study was to compare the analgesic and hemostatic effects of Local Infiltration Analgesia (LIA) with single injection femoral nerve block (SFNB). A database of patients undergoing knee arthroplasty between 2008 and 2013 was analyzed. A group of patients who underwent minimally invasive TKA either with SFNB (n = 112) or with LIA (n = 112) were matched. In the early postoperative period, the LIA group had a significantly lower VAS score, a lower drop in Hb and a lower length of hospital stay. Both the SFNB and LIA techniques provide excellent pain relief following TKA. Nevertheless, LIA reduces pain better in the very early postoperative period by a more complete nerve blockade allowing immediate postoperative mobilization and ambulation leading to a shorter hospital stay. Furthermore, LIA decreases perioperative blood loss by its local hemostatic effect.

Evaluation of pregabalin as an adjuvant to patient-controlled epidural analgesia during late termination of pregnancy.

INTRODUCTION: Late termination of pregnancy combines psychological distress with severe physical pain. The present study evaluated the benefit of adding oral pregabalin to epidural analgesia during this procedure. METHODS: Healthy women were randomly allocated to receive either oral pregabalin 150 mg/12 h or prazepam 10 mg/12 h at the induction of the late termination of pregnancy procedure. When they felt abdominal pain (numerical rating scale ranging from 0 [no pain] to 100 [worst pain possible]), patient-controlled epidural analgesia was activated and set to deliver ropivacaine 0.1% with sufentanil 0.25 µg/ml, 5 ml/h with a bolus dose of 5 ml/30 min. Rescue analgesia was available as needed by administration of 10 ml ropivacaine 0.1% (pain score less than 60/100) or 0.2% (at least 60/100). The primary outcome was the consumption of epidural analgesics. RESULTS: Forty-eight patients participated in the study. Demographic and obstetric data were similar. Pregabalin reduced total ropivacaine consumption 11.3 ± 3.2 mg/h (mean ± SD) versus 15.1 ± 4.9 mg/h in the prazepam group (P = 0.005), an effect related to a decrease in the need for rescue analgesia. In the pregabalin group, fewer women asked for rescue dose (75 vs. 96%; P = 0.048), and the number of rescue doses per patient was reduced (1 [0-2] vs. 2 [1-3]); median [interquartile range], P = 0.005), particularly the need for ropivacaine 0.2%. DISCUSSION: This is the first study considering the use of pregabalin for labor pain associated with late termination of pregnancy, showing that pregabalin 150 mg/12 h is a helpful adjuvant to epidural analgesia. Modulation of both visceral sensitization and affective component of pain may contribute to the benefits observed.