Periarticular injection in knee arthroplasty improves quadriceps function

Clin Orthop Relat Res. 2013 Jul;471(7):2284-95. doi: 10.1007/s11999-013-2928-4. Epub 2013 Mar 21.


Background: The postoperative analgesic potential of periarticular anesthetic infiltration (PAI) after TKA is unclear as are the complications of continuous femoral nerve block on quadriceps function.

Questions/purposes: We asked (1) whether PAI provides equal or improved postoperative pain control in comparison to a femoral nerve block in patients who have undergone TKA; and (2) if so, whether PAI improves early postoperative quadriceps control and facilitates rehabilitation.

Methods: We randomized 60 patients to receive either PAI or femoral nerve block. During the first 5 days after TKA, we compared narcotic consumption, pain control, quadriceps function, walking distance, knee ROM, capacity to perform a straight leg raise, and active knee extension. Medication-related side effects, complications, operating room time, and hospitalization duration were compared.

Results: Opioid consumption was lower in the PAI group during the first 8 postoperative hours (12.5 mg versus 18.7 mg morphine), as was reported pain at rest (1.7 versus 3.5 on a 10-point VAS). Thereafter, narcotic consumption and reported pain were similar up to 120 hours. More subjects in the femoral nerve block group experienced quadriceps motor block (37% versus 0% in the PAI group). On Days 1 to 3, subjects in the PAI group experienced better capacity to perform the straight leg raise, active knee extension, and had longer walking distances.

Conclusions: PAI provided pain control equivalent to that of a femoral nerve block while avoiding a motor block and its negative functional impacts. The data suggest it should be considered an alternative to a femoral nerve block.

Level of evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Amides / administration & dosage*
  • Amides / adverse effects
  • Analgesics, Opioid / therapeutic use
  • Analysis of Variance
  • Anesthetics, Local / administration & dosage*
  • Anesthetics, Local / adverse effects
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Biomechanical Phenomena
  • Bupivacaine / administration & dosage*
  • Bupivacaine / adverse effects
  • Chi-Square Distribution
  • Double-Blind Method
  • Female
  • Femoral Nerve*
  • Humans
  • Injections, Intra-Articular
  • Length of Stay
  • Male
  • Middle Aged
  • Motor Activity / drug effects
  • Nerve Block*
  • Pain Measurement
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / etiology
  • Pain, Postoperative / prevention & control*
  • Quadriceps Muscle / drug effects*
  • Quadriceps Muscle / innervation
  • Quebec
  • Range of Motion, Articular
  • Recovery of Function
  • Ropivacaine
  • Time Factors
  • Treatment Outcome
  • Walking


  • Amides
  • Analgesics, Opioid
  • Anesthetics, Local
  • Ropivacaine
  • Bupivacaine