EFFECTS OF INTRAVENOUS PATIENT-CONTROLLED ANALGESIA WITH MORPHINE, CONTINUOUS EPIDURAL ANALGESIA, AND CONTINUOUS 3-IN-ONE BLOCK ON POSTOPERATIVE PAIN AND KNEE REHABILITATION AFTER UNILATERAL TOTAL KNEE ARTHROPLASTY

In this study, we assessed the influence of three analgesic techniques on postoperative knee rehabilitation after total knee arthroplasty (T KA). Forty-five patients scheduled for elective TKA under general anes thesia were randomly divided into three groups. Postoperative analgesi a was provided with IV patient-controlled analgesia (PCA) with morphin e in Group A, continuous 3-in-1 block in Group B, and epidural analges ia in Group C. Immediately after surgery, the three groups started ide ntical physical therapy regimens. Pain scores, supplemental analgesia, side effects, degree of maximal knee flexion, day of first walk, and duration of hospital stay were recorded. Patients in Groups B and C re ported significantly lower pain scores than those in Group A. Suppleme ntal analgesia was comparable in the three groups. Compared with Group s A and C, a significantly lower incidence of side effects was noted i n Group B. Significantly better knee flexion (until 6 wk after surgery ), faster ambulation, and shorter hospital stay were noted in Groups B and C. However, these benefits did not affect outcome at 3 mo. We con clude that, after TKA, continuous 3-in-1 block and epidural analgesia provide better pain relief and faster knee rehabilitation than TV PCA with morphine. Because it induces fewer side effects, continuous 3-in- 1 block should be considered the technique of choice. Implications: In this study, we determined that, after total knee arthroplasty, loco-r egional analgesic techniques (epidural analgesia or continuous 3-in-1 block) provide better pain relief and faster postoperative knee rehabi litation than IV patient-controlled analgesia with morphine. Because i t causes fewer side effects than epidural analgesia, continuous 3-in-1 block is the technique of choice.