Local Infiltration Analgesia vs PNB Anesthesia in TKA

Abstract and Introduction

Abstract

Background: A superior analgesic method in perioperative pain-management of patients receiving total knee arthroplasty is the subject of controversial debate. Although higher cost-efficiency is claimed for the local infiltration analgesia (LIA), there is a lack of data on its costs compared to peripheral nerve block anaesthesia (PNBA). The goal of this study was to investigate the differences in immediate perioperative costs between the LIA and PNBA in treatment of patients receiving total knee arthroplasty.

Methods: The comparison was conducted based on a randomized controlled clinical trial examining 40 patients with elective, primary total knee arthroplasty (TKA, 20 patients with LIA and 20 patients with PNBA). The analysis included surgical case costs, anaesthesiological case costs, material, costs of postoperative opioid requirements and catheter review visits for patients receiving PNBA.

Results: The overall mean costs for the LIA-group were 4328.72€ and 4368.12€ for the PNBA (p = 0.851). While there was no statistically significant difference in surgical case costs, the anaesthesiological costs were lower with the LIA procedure (1370.26€ vs. 1542.45€, p = 0.048). Material costs in the LIA group were 4.18€/patient and 94.64€/patient with the PNBA. Costs for postoperative opioid requirements showed no statistically significant difference between the two procedures.

Conclusions: There is no relevant difference in immediate perioperative costs between LIA and PNBA. Shorter induction times lead to lower anaesthesiological case costs with the LIA. Overall economic aspects seem to play a less important role for determining an adequate procedure for perioperative pain management.

Trial Registration: The study was approved by the ethics-review-board of Charité Hospital Berlin (Ethikausschuss 4, Charité – Universitätsmedizin Berlin, on 16th February 2017) and registered with data safety authorities. Study patients provided written informed consent to participate in the trial. Study registry: ClinicalTrials.gov, NCT03114306.

Authors and Disclosures

Table 1. Mean, standard deviation and p-values of incision to suture time and anaesthesia induction time
	LIA n = 20	PNBA n = 20	P
Incision to suture time (O8-O10 [14] in minutes)	87.0 ± 14.0	80.0 ± 16.0	0.076
Anaesthesia induction time (min) [10]	10.0 ± 3.0	35.0 ± 26.0	< 0.001

Table 2. Material costs local infiltration analgesia (LIA)
Material	Price €/Unit	Units/Patient
Ropivacain 0.2% 200 ml/bag	3.63	1
Injection needles	0.55	1
Total	4.18

Table 3. Material costs peripheral nerve block analgesia (PNBA)
Material	Prices €/Unit	Units/Patient
Administration Set	21.09	1
Sono-Block needle	11.38	1
Sterile ultrasound cover	3.38	1
Ultrasound gel, single use	0.95	1
Sterile gloves	1.10	1
Ropivacaine 0,2% 200 ml/bag	3.63	1
Ropivacaine 7,5 mg/ml, 10 ml	1.02	2
Lidocain 1%, 10 ml	0.21	1
Prilocain 1% 20 ml	1.62€	1
Surgical gown	3.37	1
Set for regional anaesthesia (Saphenus-Catheter)	46.89	1
Total	94.64

Michael Borck^1–3, Jan D. Wandrey^1–3, Moritz Höft^1–3, Joanna Kastelik^1–3, Carsten Perka^1,2,4, Sascha Tafelski^1–3 and Sascha Treskatsch^1,2,5*

¹ Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany. ²Berlin Institute of Health , Charitéplatz 1, 10117 Berlin, Germany. ³Department of Anaesthesiology and Intensive Care, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. ⁴Centre for Musculoskeletal Surgery, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany. ⁵Department of Anaesthesiology and Intensive Care, Charité Campus Benjamin Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.

Authors' contributions
MB Conception and design of study, acquisition of data, analysis and interpretation of data, drafting the article and final approval of the version to be published. JW Analysis and interpretation of data, designing of the figure, revising the article for important intellectual content and final approval of the version to be published. MH Acquisition of data, revising the article critically for important intellectual content and final approval of the version to be published. JK Acquisition of data, revising the article critically for important intellectual content and final approval of the version to be published. CP Revising the article critically for important intellectual content and final approval of the version to be published. S. Tafelski Conception and design of study, analysis and interpretation of data, revising the article critically for important intellectual content and final approval of the version to be published. S. Treskatsch Conception and design of study, revising the article critically for important intellectual content and final approval of the version to be published.

Competing interests
MB declares no conflicts of interest. JW declares no conflicts of interest. MH declares no conflicts of interest. CP declares no conflicts of interest. JK declares no conflicts of interest. S. Tafelski received funding from two charitable foundations (AMS Stiftung, Paul-Martini Stiftung) unrelated to this study. S. Treskatsch received honoraria for lectures from Edwards, Carinopharm, Orion-Pharma and Smith & Nephews outside this work.