PERIARTICULAR REGIONAL ANALGESIA REDUCES PAIN AND HOSPITAL STAY AFTER TOTAL KNEE ARTHROPLASTY: A PROSPECTIVE, RANDOMIZED, AND DOUBLE-BLINDED CONTROLLED TRIAL

  • PULIN BIHARI DAS Department of Orthopedics, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India.
  • ANAND KUMAR SINGH Department of Orthopedics, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India.
  • ARINDAM CHATTERJEE Department of Orthopedics, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India.
  • ANURAG SINGH Department of Orthopedics, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India.

Abstract

Objective: There are multiple post-operative pain protocols for patients who undergo total knee arthroplasty (TKA). Post-operative analgesia with opioids or epidural analgesia has its side effect. We compared the duration of hospital stay, pain score, and range of motion of a control group who had no local infiltration with a group who had local infiltration analgesia following TKA.


Methods: Randomization was done in 60 patients who underwent TKA in two groups, one who did not receive and the other who received a multimodal cocktail periarticular injection containing 30 ml of 0.5% bupivacaine, 1 ml of 30 mg ketorolac, 1 ml of 1 in 1000 adrenaline, 2 ml of 80 mg gentamycin, 5 ml of 750 mg cefuroxime, and rest 0.9% of normal saline. Visual analog score (VAS) for pain at rest was recorded and assessed preoperatively and postoperatively at 2, 6, 12, 24, 36 h, 2, 3, and 7 days and during an activity at 24 h, 36 h, 2, 3, and 7 days.


Results: The patient who had received the local injection used very few analgesics over the first 24 h of surgery. Moreover, patients, where local infiltration was used, showed lower VAS for pain (at rest and during activity). They also showed higher VAS for patients’ satisfaction.


Conclusion: Due to the reduced post-operative pain with periarticular injection analgesia, it was observed that the pain and duration of hospital stay were significantly reduced.

Keywords: Total knee arthroplasty, Local infiltration, Epidural analgesia, Multimodal cocktail periarticular injection

Author Biographies

PULIN BIHARI DAS, Department of Orthopedics, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India.

Associate Professor,Department of Orthopedics

ANAND KUMAR SINGH, Department of Orthopedics, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India.

department of orthopedics

ARINDAM CHATTERJEE, Department of Orthopedics, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India.

Department of orthopedics

References

1. Ng FY, Ng JK, Chiu KY, Yan CH, Chan CW. Multimodal periarticular injection vs continuous femoral nerve block after total knee arthroplasty: A prospective, crossover, randomized clinical trial. J Arthroplasty 2012;27:11234-8.
2. Wylde V, Rooker J, Halliday L, Blom A. Acute postoperative pain at rest after hip and knee arthroplasty: Severity, sensory qualities and impact on sleep. Orthop Traumatol Surg Res 2011;97:139-44.
3. Peters CL, Shirley B, Erickson J. The effect of a new multimodal perioperative anesthetic regimen on postoperative pain, side effects, rehabilitation, and length of hospital stay after total joint arthroplasty. J Arthroplasty 2006;21:132-8.
4. 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;14:126-35.
5. 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: A prospective randomized study. J Arthroplasty 2007;22:33-8.
6. Ilfeld BM, Mariano ER, Madison SJ, Loland VJ, Sandhu NS, Suresh PJ, et al. Continuous femoral versus posterior lumbar plexus nerve blocks for analgesia after hip arthroplasty: A randomized, controlled study. Anesth Analg 2011;113:897-903.
7. Pagnano MW, Hebl J, Horlocker T. Assuring a painless total hip arthroplasty: A multimodal approach emphasizing peripheral nerve blocks. J Arthroplasty 2006;21;80-4.
8. Shep D, Khanwelkar C, Gade P, Karad S. A randomized controlled trial of curcumin and diclofenac combination in knee osteoarthritis. Int J Curr Pharm Sci 2019;11:111-4.
9. Venkatraman R, Sandhiya R. Evaluation of efficacy of epidural butorphanol tartrate for postoperative analgesia. Int J Pharm Pharm Sci 2014;7:52-4.
10. Sharma S, Iorio R, Specht LM, Davies Lepie S, Healy WL. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res 2010;468:135-40.
11. Horlocker TT, Cabanela ME, Wedel DJ. Does postoperative epidural analgesia increase the risk of peroneal nerve palsy after total knee arthroplasty? Anesth Analg 1994;79:495-500.
12. Horlocker TT, Wedel DJ. Neuraxial block and low-molecular-weight heparin: Balancing perioperative analgesia and thromboprophylaxis. Reg Anesth Pain Med 1998;23:164-77.
13. Horlocker TT, Hebl JR, Kinney MA, Cabanela ME. Opioid-free analgesia following total knee arthroplasty--a multimodal approach using continuous lumbar plexus (psoas compartment) block, acetaminophen, and ketorolac. Reg Anesth Pain Med 2002;27:105-8.
14. 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 Joint Surg Am 2006;88:959-63.
15. Hebl JR, Kopp SL, Ali MH, Horlocker TT, Dilger JA, Lennon RL, et al. A comprehensive anesthesia protocol that emphasizes peripheral nerve blockade for total knee and total hip arthroplasty. J Bone Joint Surg Am 2005;87 Suppl 2:63-70.
16. Vidya VS, Felicita AS. Efficacy of pharmacological agents in the treatment of temporomandibular joint disorder: A systematic review. Int J Pharm Pharm Sci 2015;7:54-8.
17. Dubé L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: A review. Can J Anaesth 2003;50:732-46.
18. Badner NH, Bourne RB, Rorabeck CH, MacDonald SJ, Doyle JA. Intra-articular injection of bupivacaine in knee-replacement operations. Results of use for analgesia and for preemptive blockade. J Bone Joint Surg Am 1996;78:734-8.
19. Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, et al. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 2006;88:282-9.
20. Parvataneni HK, Ranawat AS, Ranawat CS. The use of local periarticular injections in the management of postoperative pain after total hip and knee replacement: A multimodal approach. Instr Course Lect 2007;56:125-31.
21. Pang HN, Lo NN, Yang KY, Chong HC, Yeo SJ. Peri-articular steroid injection improves the outcome after unicondylar knee replacement: A prospective, randomised controlled trial with a two-year follow-up. J Bone Joint Surg Br 2008;90:738-44.
22. Lamplot JD, Wagner ER, Manning DW. Multimodal pain management in total knee arthroplasty: A prospective randomized controlled trial. J Arthroplasty 2014;29:329-34.
23. Lombardi AV Jr., Berend KR, Mallory TH, Dodds KL, Adams JB. Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop 2004;428:125-30.
24. Mullaji A, Kanna R, Shetty GM, Chavda V, Singh DP. Efficacy of periarticular injection of bupivacaine, fentanyl, and methylprednisolone in total knee arthroplasty: A prospective, randomized trial. J Arthroplasty 2010;25:851-7.
Statistics
82 Views | 79 Downloads
Citatons
How to Cite
DAS, P. B., A. K. SINGH, A. CHATTERJEE, and A. SINGH. “PERIARTICULAR REGIONAL ANALGESIA REDUCES PAIN AND HOSPITAL STAY AFTER TOTAL KNEE ARTHROPLASTY: A PROSPECTIVE, RANDOMIZED, AND DOUBLE-BLINDED CONTROLLED TRIAL”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 13, no. 7, May 2020, pp. 154-9, doi:10.22159/ajpcr.2020.v13i7.37933.
Section
Original Article(s)