Comparison of effectiveness of intraoperative subperiosteal versus periarticular analgesic cocktail injection for post operative analgesia in patients undergoing total knee arthroplasty
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20241111Keywords:
Subperiosteal, Periarticular, Arthroplasty, Cocktail, AnalgesiaAbstract
Background: Early postoperative pain management is pivotal in patients undergoing Total knee arthroplasty. The advantage of Local infiltration analgesia is its ability to provide control of pain without interfering with motor strength of the lower extremity, thereby allowing early mobilization of patients. This study compares the effectiveness of local analgesic cocktail injection given through subperiosteal vs. periarticular routes.
Methods: The study included 30 patients admitted for primary total knee arthroplasty. They were grouped into two groups based on different injection sites. Group A included patients who received subperiosteal injection and Group B included patients who received periarticular injection, under spinal anaesthesia. The difference in pain among the two groups, using VAS at 12, 24, 48, and 72 hrs postoperatively, postoperative range of movements, and Functional outcome using IKDC score at the end of 6 months were assessed and compared between the two groups.
Results: The mean VAS scores at 12, 24, 48, and 72 hrs were 0.87±0.35, 1.47±0.52, 1.80±0.41, 1.07±0.46 in subperiosteal group and 2.00±0.53, 2.47±0.52, 2.80±0.56, 1.93±0.59 in periarticular group. The 6 months postoperative IKDC scores were 51.34±0.41 and 51.04±0.61 respectively.
Conclusions: Subperiosteal cocktail injection can significantly reduce the postoperative pain and result in early recovery of range of movements, compared with periarticular cocktail injection in patients undergoing Total knee arthroplasty. But the long-term functional outcomes were comparable among both the groups.
References
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.
Wang Y, Zhou A. A new improvement: subperiosteal cocktail application to effectively reduce pain and blood loss after total knee arthroplasty. J Orthop Surg Res. 2020;15(1):33.
Fang YY, Lee QJ, Chang EWY, Wong YC. Local infiltration analgesia in primary total knee arthroplasty. Hong Kong Med J. 2019;25(4):279-86.
Bianconi M, Ferraro L, Traina G. Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery. Brit J Anaesth. 2003;91(6):830-5.
Maheshwari AV, Blum YC, Shekhar L, Ranawat AS, Ranawat CS. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res. 2009;467(6):1418-23.
Amin NH, Omiyi D, Kuczynski B, Cushner FD, Scuderi GR. The risk of a deep infection associated with intraarticular injections before a total knee arthroplasty. J Arthroplasty. 2016;31:240-4.
Xing D, Yang Y, Ma XL. Dose intraarticular steroid injection increase the rate of infection in subsequent arthroplasty: grading the evidence through a meta-analysis. J Orthop Surg Res. 2014;9:107.
Song MH, Kim BH, Ahn SJ. Peri‐articular injections of local anaesthesia can replace patient‐controlled analgesia after total knee arthroplasty: a randomised controlled study. Int Orthop. 2016;40:295-9.
Zhang LK, Ma JX, Kuang MJ, Ma XL. Comparison of periarticular local infiltration analgesia with femoral nerve block for total knee arthroplasty: a meta‐analysis of randomized controlled trials. J Arthroplasty. 2018;33:1972-8.
Wall PDH, Parsons NR, Parsons H. A pragmatic randomised controlled trial comparing the efficacy of a femoral nerve block and periarticular infiltration for early pain relief following total knee arthroplasty. Bone Joint J. 2017;99: 904-11.
Hu B, Lin T, Yan SG. Local infiltration analgesia versus regional blockade for postoperative analgesia in total knee arthroplasty: a meta‐analysis of randomized controlled trials. Pain Physician. 2016;19:205-14.
Altay N, Sarıkaya B, Karahan MA, Büyükfırat E, Binici O, Ertürk A, et al. Comparison of efficacy between combined periarticular and incisional injections versus periarticular injection alone of bupivacaine for pain control after total knee arthroplasty: a prospective randomized controlled trial. Acta Orthop Traumatol Turc. 2020;54(4):402-7.
Seangleulur A, Vanasbodeekul P, Prapaitrakool S, Worathongchai S, Anothaisintawee T, McEvoy M, Vendittoli PA, Attia J, Thakkinstian A. The efficacy of local infiltration analgesia in the early postoperative period after total knee arthroplasty: A systematic review and meta-analysis. Eur J Anaesthesiol. 2016; 33(11):816-31.
Vijayaraja A, Ram G, Ahmed F, Raghavendran R. Is multimodal pain management the new standard of care in total knee replacement?. Int J Orthop Sci. 2018;4(4): 185-7.
Li C, Qu J, Pan S. Local infiltration anesthesia versus epidural analgesia for postoperative pain control in total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2018;13:112.
Nair SV, Radhamony GN, Rajendra R, Mishra R. Effectiveness of intraoperative periarticular cocktail injection for pain control and knee motion recovery after total knee replacement. Arthroplast Today. 2019; 5(3):320-4.