Effectiveness of local infiltrative analgesia versus epidural analgesia on post-operative pain control and stress response in patient of total knee arthroplasty

Background: Postoperative pain management after total knee arthroplasty (TKA) is crucial for early mobilization and rehabilitation as well as patient satisfaction. The two main techniques of analgesia are epidural (EA) and local infiltrative (LIA) techniques, the efficacy of which is debatable. Epidural analgesia (EA) and local infiltrative analgesia (LIA) have both been shown to be effective for pain management following TKA. Objective: To compare the effects of epidural analgesia and local infiltrative analgesia methods on post-operative pain control (In-terms of mean VAS score and need of additional analgesia) in patients undergoing total knee arthroplasty.  Methods: A non-randomised interventional study was done in the Department of Anesthesia, Combined Military Hospital(CMH), Lahore from January 2026 to April 2026. Sixty patients, aged 50 to 70 years, undergoing unilateral TKA were enrolled and randomly assigned to EA group (n=30) and LIA group (n=30). The intensity of pain was evaluated at 6, 12 and 24 hours post operation by the Numeric Rating Scale (NRS). An additional finding was the need for rescue tramadol in the first 24 hours. Results: Mean NRS scores were significantly lower in the EA group 6, 12 and 24 hours after the injury than in the LIA group (p<0.05). Requirements for supplementary tramadol analgesia was also significantly less in the EA group (30.0%) than the LIA group (56.7%) (p=0.036). Conclusions: In patients undergoing TKA, epidural was effective for improved postoperative pain management and lower requirements for rescue analgesics than local infiltrative.