Infection rates with use of intra-articular pain catheters in total knee arthroplasty
Andrew Ham
Canterbury Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorNavendu Goyal
Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorIan A. Harris
Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
Search for more papers by this authorDarren B. Chen
Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorCorresponding Author
Samuel J. MacDessi
Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia
Correspondence
Dr Samuel J. MacDessi, Sydney Knee Specialists, St George Private Hospital, Suite 8, 19 Kensington Street, Kogarah, Sydney, NSW 2217, Australia. Email: [email protected]
Search for more papers by this authorAndrew Ham
Canterbury Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorNavendu Goyal
Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorIan A. Harris
Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
Search for more papers by this authorDarren B. Chen
Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia
Search for more papers by this authorCorresponding Author
Samuel J. MacDessi
Sydney Knee Specialists, St George Private Hospital, Sydney, New South Wales, Australia
Correspondence
Dr Samuel J. MacDessi, Sydney Knee Specialists, St George Private Hospital, Suite 8, 19 Kensington Street, Kogarah, Sydney, NSW 2217, Australia. Email: [email protected]
Search for more papers by this authorAbstract
Background
Intra-articular pain catheters effectively reduce postoperative pain in total knee arthroplasty (TKA) by delivering analgesia to the surgical site. However, concerns exist regarding the potential for increasing deep infections. This study tested the hypothesis that intra-articular pain catheters in TKA increase the rate of deep surgical site infections.
Methods
A retrospective analysis of 1915 patients undergoing primary TKA between January 2008 and December 2013 was undertaken, comparing infection rates between patients with intra-articular catheters inserted and those without.
Results
Deep infection rate was 0.53% with intra-articular pain catheters, compared with 0.77% when the catheters were not inserted. There was no statistically significant difference between the groups (P = 0.56).
Conclusion
Intra-articular pain catheters in TKA did not increase the rate of deep infection.
References
- 1 Brander VA, Stulberg SD, Adams AD et al. Ranawat award paper: predicting total knee replacement pain: a prospective, observational study. Clin. Orthop. 2003; 416: 27–36.
- 2 Strassels SA, Chen C, Carr DB. Postoperative analgesia: economics, resource use, and patient satisfaction in an urban teaching hospital. Anesth. Analg. 2002; 94: 130–7.
- 3 Fu PL, Xiao J, Zhu YL et al. Efficacy of a multimodal analgesia protocol in total knee arthroplasty: a randomized, controlled trial. J. Int. Med. Res. 2010; 38: 1404–12.
- 4 Vendittoli PA, Makinen P, Drolet P et al. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J. Bone Joint Surg. Am. 2006; 88: 282–9.
- 5 Bianconi M, Ferraro L, Traina GC et al. Pharmacokinetics and efficacy of ropivicaine continuous wound instillation after joint replacement surgery. Br. J. Anaesth. 2004; 91: 830–5.
- 6 Rasmussen S, Kramhoft MU, Sperling KP, Pederson JHL. Increased flexion and reduced hospital stay with continuous intraarticular morphine and ropivicaine after primary total knee replacement. Acta Orthop. Scand. 2004; 75: 606–9.
- 7 Spreng UJ, Dahl V, Hjall A, Fagerland MW, Raeder J. High-volume local infiltration analgesia combined with intravenous or local ketorolac+morphine compared with epidural analgesia after total knee replacement. Br. J. Anaesth. 2010; 105: 675–82.
- 8 Anderson KV, Bak M, Christensen BV, Harazuk J, Pederson NA, Soballe K. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty. Acta Orthop. Scand. 2010; 81: 606–10.
- 9 Axelsson K, Nordenson U, Johanzon E et al. Patient-controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression. Acta Anaesthesiol. Scand. 2003; 47: 993–1000.
- 10 Bianconi M, Ferraro L, Ricci R et al. The pharmacokinetics and efficacy of ropivacaine continuous wound instillation after spine fusion surgery. Anesth. Analg. 2004; 98: 166–72.
- 11 Blumenthal S, Dullenkopf A, Rentsch K, Borgeat A. Continuous infusion of ropivacaine for pain relief after iliac crest bone grafting for shoulder surgery. Anesthesiology 2005; 102: 392–7.
- 12 Gottschalk A, Burmeister MA, Radtke P et al. Continuous wound infiltration with ropivacaine reduces pain and analgesic requirement after shoulder surgery. Anesth. Analg. 2003; 97: 1086–91.
- 13 Klein SM, Nielsen KC, Martin A et al. Interscalene brachial plexus block with continuous intraarticular infusion of ropivacaine. Anesth. Analg. 2001; 93: 601–5.
- 14 Park JY, Lee GW, Kim Y, Yoo MJ. The efficacy of continuous intrabursal infusion with morphine and bupivacaine for postoperative analgesia after subacromial arthroscopy. Reg. Anesth. Pain Med. 2002; 27: 145–9.
- 15 Singh K, Samartzis D, Strom J et al. A prospective, randomized, double-blind study evaluating the efficacy of postoperative continuous local anesthetic infusion at the iliac crest bone graft site after spinal arthrodesis. Spine 2005; 30: 2477–83.
- 16 Barber FA, Herbert MA. The effectiveness of an anesthetic continuous-infusion device on postoperative pain control. Arthroscopy 2002; 18: 76–81.
- 17 Harvey GP, Chelly JE, Samsam TA, Coupe K. Patient-controlled ropivacaine analgesia after arthroscopic subacromial decompression. Arthroscopy 2004; 20: 451–5.
- 18 Hoenecke HR, Pulido PA, Morris BA, Fornek J. The efficacy of continuous bupivacaine infiltration following anterior cruciate ligament reconstruction. Arthroscopy 2002; 18: 854–8.
- 19 Savoie FH, Field LD, Jenkins RN, Mallon WJ, Phelps RA. The pain control infusion pump for postoperative pain control in shoulder surgery. Arthroscopy 2000; 16: 339–42.
- 20 Chester JF, Ravindranath K, White BD, Shanahan D, Taylor RS, Lloyd-Williams K. Wound perfusion with bupivacaine: objective evidence for efficacy in postoperative pain relief. Ann. R. Coll. Surg. Engl. 1989; 71: 394–6.
- 21 Lau H, Patil NG, Lee F. Randomized clinical trial of postoperative subfascial infusion with bupivacaine following ambulatory open mesh repair of inguinal hernia. Dig. Surg. 2003; 20: 285–9.
- 22 Sanchez B, Waxman K, Tatevossian R, Gamberdella M, Read B. Local anesthetic infusion pumps improve postoperative pain after inguinal hernia repair: a randomized trial. Am. Surg. 2004; 70: 1002–6.
- 23 Schurr MJ, Gordon DB, Pellino TA, Scanlon TA. Continuous local anesthetic infusion for pain management after outpatient inguinal herniorrhaphy. Surgery 2004; 136: 761–9.
- 24 Alford JW, Fadale PD. Evaluation of postoperative bupivacaine infusion for pain management after anterior cruciate ligament reconstruction. Arthroscopy 2003; 19: 855–61.
- 25 Baig MK, Zmora O, Derdemezi J, Weiss EG, Nogueras JJ, Wexner SD. Use of the ON-Q pain management system is associated with decreased postoperative analgesic requirement: double blind randomized placebo pilot study. J. Am. Coll. Surg. 2006; 202: 297–305.
- 26 Cheong WK, Seow-Choen F, Eu KW, Tang CL, Heah SM. Randomized clinical trial of local bupivacaine perfusion versus parenteral morphine infusion for pain relief after laparotomy. Br. J. Surg. 2001; 88: 357–9.
- 27 LeBlanc KA, Bellanger D, Rhynes VK, Hausmann M. Evaluation of continuous infusion of 0.5% bupivacaine by elastomeric pump for postoperative pain management after open inguinal hernia repair. J. Am. Coll. Surg. 2005; 200: 198–202.
- 28 Levack ID, Holmes JD, Robertson GS. Abdominal wound perfusion for the relief of postoperative pain. Br. J. Anaesth. 1986; 58: 615–9.
- 29 Liu SS, Richman JM, Thirlby RC, Wu CL. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J. Am. Coll. Surg. 2006; 203: 914–32.
- 30 Casey BH. Bacterial spread in polyethylene tubing: a possible source of surgical wound contamination. Med. J. Aust. 1971; 2: 718–9.
- 31 Horan TC, Gaynes RP, Martone WT, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect. Control Hosp. Epidemiol. 1992; 13: 606–8.
- 32 Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. Am. J. Infect. Control 1988; 16: 128–40.
- 33 Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J. Bone Joint Surg. Am. 1996; 78: 512–23.
- 34 Bengston S, Blomgren G, Knutson K, Wigren A, Lidgren L. Hematogenous infection after knee arthroplasty. Acta Orthop. Scand. 1987; 58: 529–34.
- 35 McDonald DA, Siegmeth R, Deakin AH, Kinninmonth AWG, Scott NB. An enhanced recovery programme for primary total knee arthroplasty in the United Kingdom – follow up at one year. Knee 2012; 19: 525–9.
- 36 Vintar N, Rawal N, Veselko M. Intraarticular patient-controlled regional anaesthesia after arthroscopically assisted anterior cruciate ligament reconstruction: ropivicaine/morphine/ketorolac versus ropivicaine/morphine. Anesth. Analg. 2005; 101: 573–8.
- 37 Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tonnesen EK, Soballe K. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty. Acta Orthop. Scand. 2007; 78: 172–9.
- 38 Essving P, Axelsson K, Kjellberg J, Wallgren O, Gupta A, Lundin A. Reduced hospital stay, morphine consumption and pain intensity with local infiltration analgesia after unicompartmental arthroplasty. Acta Orthop. Scand. 2009; 80: 213–9.
- 39 Essving P, Axelsson K, Aberg E, Spannar H, Gupta A, Lundin A. Local infiltration analgesia versus intrathecal morphine for postoperative pain management after a total knee arthroplasty: a randomised controlled trial. Anesth. Analg. 2011; 113: 926–33.
- 40 Oakley MJ, Smith JS, Anderson JR, Fenton-Lee D. Randomized placebo-controlled trial of local anaesthetic infusion in day-case inguinal hernia repair. Br. J. Surg. 1998; 85: 797–9.
- 41 Thomas DFM, Lambert WG, Lloyd WK. The direct perfusion of surgical wounds with local anaesthetic solution: an approach to postoperative pain? Ann. R. Coll. Surg. Engl. 1983; 65: 226–9.
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