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      Effects of periarticular injection on analgesic effects and NSAID use in total knee arthroplasty and total hip arthroplasty

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          Abstract

          OBJECTIVES:

          This study examined periarticular multimodal drug injection and the use of nonsteroidal anti-inflammatory drugs for an early analgesic effect after total knee arthroplasty and total hip arthroplasty. Patient satisfaction and benefits from the treatment were also assessed.

          METHODS:

          A total of 110 patients who were scheduled to undergo total knee arthroplasty and 86 patients who were scheduled to undergo total hip arthroplasty were divided into two groups, the study group and the control group. The study group received a periarticular multimodal drug injection during surgery. The control group received an equal volume of normal saline. All patients received an analgesia pump and a moderate dose of nonsteroidal anti-inflammatory drugs. Resting and motion Numeric Rating Scale scores, the Western Ontario and McMaster Universities Arthritis Index, knee or hip joint range of motion, length of postoperative hospital stay, patient satisfaction, total nonsteroidal anti-inflammatory drug consumption and side effects were recorded.

          RESULTS:

          Both study groups exhibited significant improvement in pain Numeric Rating Scale scores during rest and exercise several days after the surgery. The range of joint motion was greater in the study group, and the length of postoperative hospital stay was shorter than that in the control group. Patients in the study group consumed fewer nonsteroidal anti-inflammatory drugs and reported greater satisfaction with surgery.

          CONCLUSION:

          Intraoperative periarticular multimodal drug injection significantly relieved pain after surgery and reduced nonsteroidal anti-inflammatory drug consumption. These patient had a better postoperative experience, including satisfaction and rehabilitation.

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          Most cited references26

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          Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial.

          Postoperative analgesia with the use of parenteral opioids or epidural analgesia can be associated with troublesome side effects. Good perioperative analgesia facilitates rehabilitation, improves patient satisfaction, and may reduce the hospital stay. We investigated the analgesic effect of locally injected drugs around a total knee prosthesis. Sixty-four patients undergoing total knee arthroplasty were randomized either to receive a periarticular intraoperative injection containing ropivacaine, ketorolac, epimorphine, and epinephrine or to receive no injection. The perioperative analgesic regimen was standardized. All patients in both groups received patient-controlled analgesia for twenty-four hours after the surgery, and this was followed by standard analgesia. Visual analog scores for pain, during activity and at rest, and for patient satisfaction were recorded preoperatively and postoperatively and at the six-week follow-up examination. The consumption of patient-controlled analgesia at specific postoperative time-points and the overall analgesic requirement were measured. The patients who had received the injection used significantly less patient-controlled analgesia at six hours, at twelve hours, and over the first twenty-four hours after the surgery. In addition, they had higher visual analog scores for patient satisfaction and lower visual analog scores for pain during activity in the post-anesthetic-care unit and four hours after the operation. No cardiac or central nervous system toxicity was observed. Intraoperative periarticular injection with multimodal drugs can significantly reduce the requirements for patient-controlled analgesia and improve patient satisfaction, with no apparent risks, following total knee arthroplasty.
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            Pain management and accelerated rehabilitation for total hip and total knee arthroplasty.

            Improved pain management techniques and accelerated rehabilitation programs are revolutionizing our patients' postoperative experience after total hip and knee arthroplasty. The process involves regional anesthesia with multimodal pain control using local periarticular injections in combination with enhanced patient education and accelerated rehabilitation provided by a dedicated team of surgeons, physicians, anesthesiologists, physician assistants, physical therapists, and social workers. With this system, it is now possible to achieve a painless recovery after total hip arthroplasty and total knee arthroplasty. Although this is not always the case, it was unheard of in prior years. It is our hope that future research into this area will make painful, difficult recoveries after total hip arthroplasty and total knee arthroplasty a distant memory.
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              Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty

              Background and purpose Postoperative pain is often severe after total knee arthroplasty (TKA). We investigated the efficacy of the local infiltration analgesia (LIA) technique, both intraoperatively and postoperatively. Methods 48 patients undergoing TKA were randomized into 2 groups in a double-blind study. In group A, 400 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine were infiltrated periarticularly during operation. In group P, no injections were given. 21 h postoperatively, 200 mg ropivacaine, 30 mg ketorolac, and 0.1 mg epinephrine were injected intraarticularly in group A, and the same volume of saline was injected in group P. All patients were followed up for 3 months. Results Median morphine consumption was lower in group A during the first 48 h: 18 (1–74) mg vs. 87 (36–160) mg in group P. Postoperative pain was lower at rest in group A during the first 27 h, and on movement during the first 48 h, except at 21 h. Time to fulfillment of discharge criteria was shorter in group A than in group P: 3 (1–7) vs. 5 (2–8) days. Patient satisfaction was higher in group A than in group P on days 1 and 7. The unbound venous blood concentration of ropivacaine was below systemic toxic blood concentrations. Interpretation The local infiltration analgesia (LIA) technique provides excellent pain relief and lower morphine consumption following TKA, resulting in shorter time to home readiness and higher patient satisfaction. There were few side effects and systemic LA concentrations were low.
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                Author and article information

                Journal
                Clinics (Sao Paulo)
                Clinics (Sao Paulo)
                Clinics
                Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                1807-5932
                1980-5322
                December 2017
                December 2017
                : 72
                : 12
                : 729-736
                Affiliations
                The First Department of Orthopedics, the Second Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an Shaanxi, 710004, P. R China
                Author notes
                Article
                cln_72p729
                10.6061/clinics/2017(12)03
                5738568
                29319718
                2e4be260-7fe2-4de1-9c51-02c8dc758a21
                Copyright © 2017 CLINICS

                This is an Open Access article distributed under the terms of the Creative Commons License ( http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

                History
                : 29 June 2017
                : 24 August 2017
                : 3 October 2017
                Categories
                Clinical Science

                Medicine
                arthroplasty,pain,knee,hip,analgesia,nonsteroidal anti-inflammatory drugs
                Medicine
                arthroplasty, pain, knee, hip, analgesia, nonsteroidal anti-inflammatory drugs

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