Efficacy of local anaesthetic cocktail infiltration in a total knee replacement: a prospective, randomized study

Authors

  • Ameya U. Kulkarni Department of Arthroplasty and Sports Medicine, Sanjivan Hospital, Nashik, India
  • Umesh M. Kulkarni Department of Arthroplasty and Sports Medicine, Sanjivan Hospital, Nashik, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20203719

Keywords:

Arthroplasty, Total knee replacement, Pain management, Visual analogue scale

Abstract

Background: The aim of this study is to assess the efficacy of local anaesthetic cocktail infiltration in pain management during a total knee arthroplasty.

Methods: In this study we had 25 patients each in study and control group. The study group was infiltrated with the local anesthetic cocktail just before final implantation. Pain was documented by a visual analogue scale in a double blinded manner. Statistical significance was calculated using an unpaired “t” test.

Results: In study group, pain levels were significantly lower as compared to control group for the first 48 hours after surgery with a ‘p’ value of 0.0224 (<0.05). The need of intravenous tramadol for breakthrough pain on the second day was significantly lower in study group as compared to control group with a ‘p’ value of 0.033(<0.05).

Conclusions: This study shows that the local high volume anaesthetic infiltration is effective in reducing immediate postoperative pain and the need of IV opioids for the first 48 hours after surgery.

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References

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(2):139-44.

Riegler FX. Update on perioperative pain management. Clin Orthop Relat Res. 1994;305:283-92.

Seah VW, Chin PL, Chia SL, Yang KY, Lo NN, Yeo SJ. Single-dose peri-articular steroid infiltration for pain management in total knee arthroplasty: a prospective, double-blind, randomized controlled trial. Singapore Med J. 2011;52(1):19-23.

Kehlet H. Surgical stress: the role of pain and analgesia. BJA: Br J Anaesth. 1989;63(2):189-95.

Woolf CJ, Chong MS. Preemptive analgesia: treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993;77(2):362-79.

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. JBJS. 1996;78(5):734-8.

Tanaka N, Sakahashi H, Sato E, Hirose K, Ishii S. The efficacy of intra-articular analgesia after total knee arthroplasty in patients with rheumatoid arthritis and in patients with osteoarthritis. J Arthroplasty. 2001;16(3):306-11.

Mauerhan DR, Campbell M, Miller JS, Mokris JG, Gregory A, Kiebzak JM. Intra- articular morphine and/or bupivacaine in the man- agement of pain after total knee arthroplasty. J Ar- throplasty. 1997;12(5):546-52.

Joris JL, Dubner R, Hargreaves KM. Opioid analgesia at peripheral sites: a target for opioids released during stress and inflammation. Anesth Analg. 1987;66(12):1277-81.

Badner NH, Bourne RB, Rorabeck CH, MacDonald SJ, Doyle JA. Intra- articular injection of bupivacaine in knee-replacement operations. J Bone Joint Surg Am. 1996;78(5):734-8.

Allen GC, St. Amand MA, Lui AC, Johnson DH, Lindsay MP. Postarthroscopy analgesia with intraarticular bupivacaine/morphine. Anesthesiology 79(3):475-80.

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 2006;88(5):959-63.

Lombardi Jr AV, 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.

Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, Varin F. A multimodal analgesia protocol for total knee arthroplasty: a randomized, controlled study. J Bone Joint Surg 2006;88(2):282-9.

Mullaji A, Kanna R, Shetty GM, Chavda V, Singh DP. Efficacy of periarticular injection of bupivacaine, fentanyl and methyl prednisolone in total knee arthroplasty. J Arthroplasty. 2010;25(6):851-7.

Parvataneni HK, Ranawat AS, Ranawat CS. The use of local peri-articular injections in the management of postoperative pain after total hip and knee replacement: a multimodal approach. Instr Course Lect. 2007;56:125-31.

Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat RS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty. 2007;22(6):33-8.

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Published

2020-08-26

How to Cite

Kulkarni, A. U., & Kulkarni, U. M. (2020). Efficacy of local anaesthetic cocktail infiltration in a total knee replacement: a prospective, randomized study. International Journal of Research in Orthopaedics, 6(5), 992–995. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20203719

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Original Research Articles