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Additional pain relieving effect of intraoperative periarticular injections after simultaneous bilateral TKA: a randomized, controlled study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

The authors investigated the clinical value of intraoperative periarticular multimodal drug injections (PMDI) in patients on continuous epidural analgesia after simultaneous bilateral TKAs. In 55 patients scheduled to undergo simultaneous bilateral TKAs, one knee was randomly assigned to the PMDI group for which intraoperative periarticular injections were administered and the other knee was assigned to the No-PMDI group for which the injections were not done. These two groups were compared for pain level (during the operation night and on postoperative days (POD) 1, 4, and 7), functional recovery (ability to perform straight leg raising on POD 1 and maximum flexion on POD 7), patient satisfaction (POD 7), and the incidence of wound complications. The PMDI group showed a lower pain level during the operation night and on POD 1 than the No-PMDI group, but no differences in pain levels were observed between the groups on POD 4 or 7. Furthermore, no significant group differences were found in terms of functional recovery, patient satisfaction. No wound complication has been occurred in the PMDI group. This study demonstrates that PMDI provides additional pain relief limited to the immediate postoperative period but does not improve pain relief after POD 1, patient satisfaction and functional recovery.

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References

  1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  2. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL (2003) Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 290:2455–2463

    Article  CAS  PubMed  Google Scholar 

  3. Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, Rorabeck CH, McCalden RW (2006) Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 88:959–963

    Article  PubMed  Google Scholar 

  4. Cohen RG, Forrest CJ, Benjamin JB (1997) Safety and efficacy of bilateral total knee arthroplasty. J Arthroplasty 12:497–502

    Article  CAS  PubMed  Google Scholar 

  5. Hebl JR, Dilger JA, Byer DE, Kopp SL, Stevens SR, Pagnano MW, Hanssen AD, Horlocker TT (2008) A pre-emptive multimodal pathway featuring peripheral nerve block improves perioperative outcomes after major orthopedic surgery. Reg Anesth Pain Med 33:510–517

    PubMed  Google Scholar 

  6. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  7. Johanson NA, Lachiewicz PF, Lieberman JR, Lotke PA, Parvizi J, Pellegrini V, Stringer TA, Tornetta P 3rd, Haralson RH 3rd, Watters WC 3rd (2009) Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. J Am Acad Orthop Surg 17:183–196

    PubMed  Google Scholar 

  8. Kampe S, Weigand C, Kaufmann J, Klimek M, Konig DP, Lynch J (1999) Postoperative analgesia with no motor block by continuous epidural infusion of ropivacaine 0.1% and sufentanil after total hip replacement. Anesth Analg 89:395–398

    Article  CAS  PubMed  Google Scholar 

  9. Kerr DR, Kohan L (2008) 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 79:174–183

    Article  PubMed  Google Scholar 

  10. Kim HA, Kim S, Seo YI, Choi HJ, Seong SC, Song YW, Hunter D, Zhang Y (2008) The epidemiology of total knee replacement in South Korea: national registry data. Rheumatology (Oxford) 47:88–91

    Article  Google Scholar 

  11. Kim JM, Moon MS (1995) Squatting following total knee arthroplasty. Clin Orthop Relat Res 313:177–186

    PubMed  Google Scholar 

  12. Kopacz DJ, Sharrock NE, Allen HW (1999) A comparison of levobupivacaine 0.125%, fentanyl 4 microg/mL, or their combination for patient-controlled epidural analgesia after major orthopedic surgery. Anesth Analg 89:1497–1503

    Article  CAS  PubMed  Google Scholar 

  13. Lombardi AV Jr, Berend KR, Mallory TH, Dodds KL, Adams JB (2004) Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res 428:125–130

    Article  PubMed  Google Scholar 

  14. Lu H, Mehdi G, Zhou D, Lin J (1996) Simultaneous bilateral total knee arthroplasty for rheumatoid arthritis. Chin Med J 109:937–940

    CAS  PubMed  Google Scholar 

  15. Maheshwari AV, Blum YC, Shekhar L, Ranawat AS, Ranawat CS (2009) Multimodal pain management after total hip and knee arthroplasty at the Ranawat orthopaedic center. Clin Orthop Relat Res 467:1418–1423

    Article  PubMed  Google Scholar 

  16. Mahoney OM, Noble PC, Davidson J, Tullos HS (1990) The effect of continuous epidural analgesia on postoperative pain, rehabilitation, and duration of hospitalization in total knee arthroplasty. Clin Orthop Relat Res 260:30–37

    PubMed  Google Scholar 

  17. Park KK, Shin KS, Chang CB, Kim SJ, Kim TK (2007) Functional disabilities and issues of concern in female Asian patients before TKA. Clin Orthop Relat Res 461:143–152

    PubMed  Google Scholar 

  18. Parvataneni HK, Ranawat AS, Ranawat CS (2007) The use of local periarticular injections in the management of postoperative pain after total hip and knee replacement: a multimodal approach. Instr Course Lect 56:125–131

    PubMed  Google Scholar 

  19. Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS (2007) Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty 22:33–38

    Article  PubMed  Google Scholar 

  20. Parvizi J, Porat M, Gandhi K, Viscusi ER, Rothman RH (2009) Postoperative pain management techniques in hip and knee arthroplasty. Instr Course Lect 58:769–779

    PubMed  Google Scholar 

  21. Peters CL, Shirley B, Erickson J (2006) 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 21:132–138

    Article  PubMed  Google Scholar 

  22. Powell RS, Pulido P, Tuason MS, Colwell CW Jr, Ezzet KA (2006) Bilateral vs unilateral total knee arthroplasty: a patient-based comparison of pain levels and recovery of ambulatory skills. J Arthroplasty 21:642–649

    Article  PubMed  Google Scholar 

  23. Ranawat AS, Ranawat CS (2007) Pain management and accelerated rehabilitation for total hip and total knee arthroplasty. J Arthroplasty 22:12–15

    Article  PubMed  Google Scholar 

  24. Sinatra RS, Torres J, Bustos AM (2002) Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg 10:117–129

    PubMed  Google Scholar 

  25. Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tonnesen EK, Soballe K (2007) Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop 78:172–179

    Article  PubMed  Google Scholar 

  26. Trousdale RT, McGrory BJ, Berry DJ, Becker MW, Harmsen WS (1999) Patients’ concerns prior to undergoing total hip and total knee arthroplasty. Mayo Clin Proc 74:978–982

    Article  CAS  PubMed  Google Scholar 

  27. Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, Varin F (2006) A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 88:282–289

    Article  PubMed  Google Scholar 

  28. Viscusi ER (2005) Emerging techniques in the management of acute pain: epidural analgesia. Anesth Analg 101:S23–S29

    Article  PubMed  Google Scholar 

  29. Viscusi ER, Parvizi J, Tarity TD (2007) Developments in spinal and epidural anesthesia and nerve blocks for total joint arthroplasty: what is new and exciting in pain management. Instr Course Lect 56:139–145

    PubMed  Google Scholar 

  30. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  PubMed  Google Scholar 

  31. Wheatley RG, Schug SA, Watson D (2001) Safety and efficacy of postoperative epidural analgesia. Br J Anaesth 87:47–61

    Article  CAS  PubMed  Google Scholar 

  32. Zaric D, Boysen K, Christiansen C, Christiansen J, Stephensen S, Christensen B (2006) A comparison of epidural analgesia with combined continuous femoral-sciatic nerve blocks after total knee replacement. Anesth Analg 102:1240–1246

    Article  PubMed  Google Scholar 

  33. Zeni JA Jr, Snyder-Mackler L (2009) Clinical outcomes after simultaneous bilateral total knee arthroplasty comparison to unilateral total knee arthroplasty and healthy controls. J Arthroplasty Apr 7. [Epub ahead of print]

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Correspondence to Tae Kyun Kim.

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Koh, I.J., Kang, Y.G., Chang, C.B. et al. Additional pain relieving effect of intraoperative periarticular injections after simultaneous bilateral TKA: a randomized, controlled study. Knee Surg Sports Traumatol Arthrosc 18, 916–922 (2010). https://doi.org/10.1007/s00167-010-1051-2

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  • DOI: https://doi.org/10.1007/s00167-010-1051-2

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