Effectiveness of Periarticular Infiltration of the Knee during Total Knee Arthroplasty for Postoperative Pain Management
Abstract
Background: Different treatment regimens of analgesia, nerve blocks and epidurals are used for pain relief in Total Knee Arthroplasty (TKA). Local infiltration analgesia (LIA) is one of the modalities in which a cocktail combination of different medicines is infiltrated locally into the capsule, surrounding tissues or intraarticular joint space. This study aims to analyze the effectiveness of periarticular injection of combination drugs (Bupivacaine, Ketorolac and Morphine) during TKA for postoperative pain management.
Methods: Total of 150 patients who underwent primary unilateral TKA were randomly categorized into 2 groups (75 each). Group A (control group) didn’t receive intraoperative periarticular injection but Group-B received the intraoperative injection of combined local analgesics and anaesthetics (Bupivacaine, Ketorolac and Morphine). Pain following surgery at 0, 1, and 2 postoperative days were recorded with visual analogue scale (VAS) whereas Knee Society Score was used to evaluate the pain and function pre-operative and 3 months’ post-operative. Statistical analysis was done using SPSS software.
Results: Patients receiving periarticular infiltration of combination drugs intraoperatively had lower VAS for postoperative pain (p < 0.001) and this group also showed reduced need of analgesia postoperatively.
Conclusions: Periarticular infiltration of knee during Total Knee Arthroplasty is effective in management of postoperative pain
Keywords: Periarticular; Total Knee Arthroplasty; combination drugs; postoperative pain
References
Ranawat AS, Ranawat CS. Pain Management and Accelerated Rehabilitation for Total Hip and Total Knee Arthroplasty. J Arthroplasty. 2007;22(7):12–5. https://doi.org/10.1016/j.arth.2007.05.040
Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling Pain After Total Hip and Knee Arthroplasty Using a Multimodal Protocol with Local Periarticular Injections. J Arthroplasty. 2007;22(6):33–8. https://doi.org/10.1016/j.arth.2007.03.034
Kakar P, Deshmukh U, Gagrani V, Popli G. Post-operative analgesia regime following joint replacement. Indian J Anaesth. 2011;55(3):305. http://www.ijaweb.org/text.asp?2011/55/3/305/82681
McCormack K, Brune K. Dissociation Between the Antinociceptive and Anti-Inflammatory Effects of the Nonsteroidal Anti-Inflammatory Drugs: A Survey of Their Analgesic Efficacy. Drugs. 1991;41(4):533–47. https://doi.org/10.2165/00003495-199141040-00003
Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tønnesen EK, Søballe K. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: A randomized clinical trial. Acta Orthop. 2007;78(2):172–9. https://doi.org/10.1080/17453670710013645
Andersen LØ, Husted H, Otte KS, Kristensen BB, Kehlet H. High-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial: Local infiltration analgesia in knee arthroplasty. Acta Anaesthesiol Scand. 2008 17;52(10):1331–5. https://doi.org/10.1111/j.1399-6576.2008.01777.x
Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, et al. Efficacy of Periarticular Multimodal Drug Injection in Total Knee Arthroplasty: A Randomized Trial. J Bone Jt Surg. 2006;88(5):959–63. https://doi.org/10.2106/JBJS.E.00344
Feldman HS. Toxicity of local anaesthetic agents. In: Rice SA, Fish KJ, editors. Anesthetic toxicity. New York: Raven Press; 1994. p 107-33. In. [Book Section]
Stein C. Peripheral Mechanisms of Opioid Analgesia. In: Herz A, Akil H, Simon EJ, editors. Opioids II [Internet]. Berlin, Heidelberg: Springer Berlin Heidelberg; 1993 [cited 2020 Nov 28]. p. 91–103. (Handbook of Experimental Pharmacology; vol. 104 / 2). Available from: http://link.springer.com/10.1007/978-3-642-77540-6_4
Scuderi GR. Peri-Articular Regional Analgesia in Total Knee Arthroplasty. A Review of The Neuroanatomy and Injection Technique. 2014;6. https://doi.org
Klasen JA, Opitz SA, Melzer C, Thiel A, Hempelmann G. Intraarticular, epidural, and intravenous analgesia after total knee arthroplasty: Analgesia after total knee arthroplasty. Acta Anaesthesiol Scand. 1999;43(10):1021–6. https://doi.org/10.1034/j.1399-6576.1999.431009.x
Smith I, Van Hemelrijck J, White PF, Shively R. Effects of local anesthesia on recovery after outpatient arthroscopy. Anesth Analg. 1991;73(5):536–9.
Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: A case study of 325 patients. Acta Orthop. 2008;79(2):174–83. https://doi.org/10.1080/17453670710014950
Horlocker TT, Kopp SL, Pagnano MW, Hebl JR. Analgesia for Total Hip and Knee Arthroplasty: A Multimodal Pathway Featuring Peripheral Nerve Block: J Am Acad Orthop Surg. 2006;14(3):126–35. https://doi.org/10.5435/00124635-200603000-00003
Stein C. The Control of Pain in Peripheral Tissue by Opioids. Epstein FH, editor. N Engl J Med. 1995;332(25):1685–90. https://doi.org/10.1056/NEJM199506223322506
Woolf CJ, Chong MS. Preemptive analgesia— treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993;77:362-79. https://doi.org/10.1213/00000539-199377020-00026
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