The Use of Continuous Wound Infusion Analgesia in Total Knee Arthroplasty

• Post-operative nausea and vomiting [ Time Frame: Post-operatively for three days ] [ Designated as safety issue: Yes ]
• Narcotic medications taken [ Time Frame: Post-operatively for three days ] [ Designated as safety issue: Yes ]
• Time to first mobilization, first transfer and first 30-M walk [ Time Frame: Up to three days post-operatively ] [ Designated as safety issue: Yes ]
• Number of adverse events [ Time Frame: Three days post-op (observed) then at follow-up (self-report) ] [ Designated as safety issue: Yes ]
• Length of Stay [ Time Frame: Time of surgery to discharge ] [ Designated as safety issue: No ]
• Satisfaction (patient and caregiver) [ Time Frame: Discharge from hospital ] [ Designated as safety issue: No ]

The main purpose of this study is to determine if there is improvement in pain and other patient outcomes when using a continuous wound analgesia system after total knee replacement, compared to usual methods of pain control. Another purpose is to determine if the system makes it easier for nurses to care for these patients.

Continuous local wound infusion analgesia is a relatively new way of managing post-operative pain, whereby a local anesthetic is continuously infused into the surgical area. Some studies and users have reported decreased pain, decreased opioid use, decreased post-operative nausea and vomiting, decreased length of stay, and improved patient and caregiver satisfaction with the use of continuous local wound infusion analgesia, when compared to placebo, or usual care, in arthroplasty and other surgical interventions.

Hypotheses:

Primary:

The On-Q PainBuster (continuous wound infusion analgesia) in TKA will result in improved patient pain control, compared to usual care.

Secondary:

• Pain scores post-operatively will be better than usual care.
• Fewer narcotics will be ingested post-operatively than with usual care.
• Post-op nausea and vomiting will be less than usual care.
• Length of stay will be shorter compared to usual care.
• Patient satisfaction will be greater than satisfaction with usual care.
• Post-operative infection rates will be no different between groups.
• Fall rates will be no different between groups.
• Subjects will participate in physical therapy the day of surgery.
• Nursing Intensity requirements will be less with the wound infusion due to fewer requests for pain medication.

• Device: On-Q PainBuster with Bupivacaine
  On-Q PainBuster continuous wound infusion analgesia system, using bupivacaine as the local anaesthetic
• Device: Usual Care
  Usual Care

• Experimental: S
  Patients receive the On-Q local continuous wound infusion system intra-operatively and use it for up to three days post-operatively.
  Intervention: Device: On-Q PainBuster with Bupivacaine
• Active Comparator: C
  Usual care - post operative pain medications as per the knee arthroplasty care map.
  Intervention: Device: Usual Care

Inclusion Criteria:

• Scheduled for TKA at the Royal Alexandra Hospital
• Patient of Dr. Arnett
• Deemed fit for continuous wound infusion (no allergies to Bupivacaine or related medications) by anesthesia
• Cognitively aware, and provides informed consent
• Elective (not trauma-related) surgery
• Able to read, speak and understand English
• Adult < 70 years of age
• Intra-operative spinal anaesthesia
• Reside within metropolitan Edmonton, in a bungalow
• Have a caregiver at home
• ASA risk classification of 1 or 2
• Do not regularly use opioid medication pre-operatively
• Have preoperative knee range of motion > 90 degrees
• Body Mass Index < 40
• No known hepatic or liver insufficiency

Exclusion Criteria:

• Deemed unfit for continuous wound infusion due to allergies
• Other exclusion criteria to be determined