Is a standard intravenous patient-controlled analgesia protocol sufficient for patients with bilateral knee arthroplasty?

The aim of this study is to investigate whether patients undergoing one-stage bilateral total knee arthroplasty and those undergoing unilateral total knee arthroplasty differed in their responses to a standard intravenous patient-controlled analgesia protocol. Data from patients with the physiological status I-III according to American Society of Anesthesiologists, aged 18-99 years, undergoing one-stage bilateral or unilateral total knee arthroplasty under spinal anesthesia between January 2014 and December 2017 and offered a standard intravenous patient-controlled analgesia with morphine were retrospectively reviewed. Demographic data, Visual Analogue Scale scores and postoperative complications were examined. The total dose of analgesics consumed, analgesia demands, doses delivered and the ratio of delivered doses to demands in 0- 24 hours and 24-48 hours after surgery available in the patient-controlled analgesia pump monitoring forms were recorded. Records about 68 patients who had one-stage bilateral total knee arthroplasty and 124 patients who had unilateral total knee arthroplasty were accessed. The analgesia demands and analgesic doses delivered and utilized by the patients with one-stage bilateral total knee arthroplasty were significantly higher in 0-24 hours and 24-48 hours after surgery. Side-effects of the analgesia were similar in both groups. Visual Analogue Scale scores in 24-48 hours after surgery were higher in the patients with unilateral total knee arthroplasty. Although the patients with one-stage total knee arthroplasty received significantly higher doses of morphine, side-effects due to this opioid did not differ significantly. This showed that the standard intravenous patient-controlled analgesia protocol utilized was reliable and effective in both patient groups.