Local infiltration analgesia versus peripheral nerve block anaesthesia in total knee arthroplasty: a pharmaco-economic comparison

Michael Borck, Jan D Wandrey, Moritz Höft, Joanna Kastelik, Carsten Perka, Sascha Tafelski, Sascha Treskatsch, Michael Borck, Jan D Wandrey, Moritz Höft, Joanna Kastelik, Carsten Perka, Sascha Tafelski, Sascha Treskatsch

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 .

Keywords: Cost comparison; Local infiltration analgesia; Pain management; Peripheral nerve block.

Conflict of interest statement

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, OrionPharma and Smith & Nephews outside this work.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Stacked bar charts display mean distribution of separated costs per patient by study group. Error bars indicate 95% confidence interval for mean distribution of overall costs per patient

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