The Effectiveness of Anesthetic Techniques and Postoperative Pain Management after Total Knee Arthroplasty at Pathum Thani Hospital
Keywords:
Postoperative analgesia, Peripheral nerve block, Total knee arthroplastyAbstract
Total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis; however, many patients experience severe pain in the early postoperative period. This study aimed to compare the effectiveness of different anesthetic techniques and postoperative pain management. A retrospective analytical study was conducted in 549 patients undergoing TKA at Pathum Thani Hospital between 2023 and 2025. The patients were categorized into five groups: spinal anesthesia with local infiltration analgesia (SA+LIA), spinal anesthesia with intrathecal morphine plus LIA (SAMO+LIA), SA+LIA with peripheral nerve block (SA+LIA+PNB; subdivided into adductor canal block [ACB] and femoral triangle block [FTB]), general anesthesia with LIA (GA+LIA), and GA+LIA+PNB. Outcomes included numeric rating scale at 6, 12, 24, and 48 hours, cumulative morphine consumption, and adverse event incidence. Data were analyzed using Fisher's exact test, One-way ANOVA and independent t-Test.
Postoperative pain scores differed significantly across groups (p < 0.001). The SA+LIA+PNB group demonstrated superior analgesia, achieving the lowest NRS scores at all intervals (mean NRS: 3.98, 3.31, 2.41, and 2.23, respectively). No significant differences were observed between ACB and FTB. Cumulative morphine consumption did not significantly differ among groups. The most common adverse event was nausea and vomiting (24.4%), occurring most frequently in the SAMO+LIA group (42.2%, p = 0.024).
The combination of SA, PNB, and LIA provides effective pain control and safety for TKA and supports enhanced recovery, despite the absence of a significant opioid-sparing effect.
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