Journal of Orthopedics and Joint Surgery

Register      Login

VOLUME 3 , ISSUE 1 ( January-June, 2021 ) > List of Articles

Original Article

A Randomized Clinical Trial Assessing the Efficacy of Periarticular Injection (LIA) during Total Knee Joint Replacement in the Asian Population

Venkatappa Somashekar, Anandsrinivas Sowlee, Prahalad K Singhi, Venkatasamy Pandiarajan Raghava Kumar

Citation Information : Somashekar V, Sowlee A, Singhi PK, Kumar VP. A Randomized Clinical Trial Assessing the Efficacy of Periarticular Injection (LIA) during Total Knee Joint Replacement in the Asian Population. 2021; 3 (1):41-50.

DOI: 10.5005/jp-journals-10079-1030

License: CC BY-NC 4.0

Published Online: 07-07-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Introduction: Osteoarthritis patients usually come very late in the natural course often having bilateral involvement of degenerative changes. Patients are counseled and advised for staged procedures, however, after the first knee surgery, due to postoperative pain, the majority of them are reluctant to undergo total knee arthroplasty (TKA) in the other knee. We did a prospective randomized double-blind control study comparing the amount of analgesic required in the immediate postoperative period in those patients who received a periarticular cocktail injection and those who did not, following TKA. Materials and methods: This was a single-center prospective randomized controlled, double-blind, clinical analysis comparing 126 patients receiving intraoperative analgesia cocktail and control group during TKA. Group I (n 72) received local infiltration of analgesic (LIA), group II (n 54) did not receive any injection. Patients were assessed for pain in terms of visual analog scale (VAS) score, postoperative analgesia requirement, and knee range of motion. Results: The mean postoperative Oxford knee score at 2 months of group I was 30.47 (SD 4.45) compared with group II was 30.30 (SD 5.44). There was a significantly lower mean VAS score (3.16) in group I than group II (7.45) and was statistically significant with a p value of 0.0005. At the end of 2 months, both the groups had similar degrees of range of motion. Conclusion: Local infiltration of analgesia during TKA with our combination of drugs effectively reduces postoperative pain and decreased analgesic consumption, without adding much to the cost of the surgery and also significantly improves patient compliance and rehabilitation.


HTML PDF Share
  1. Giuffre M, Asci J, Arnstein P, et al. Postoperative joint arthroplasty pain: description and opioid requirement. J Post Anesth Nurs 1991;6:239–245.
  2. Kahlenberg CA, Nwachukwu BU, Mclawhorn AS, et al. Patient satisfaction after total knee arthroplasty: a systematic review n.d. HSS J 2018;14(2):192–201. DOI: 10.1007/s11420-018-9614-8.
  3. Pettine KA, Wedel DJ, Cabanela ME, et al. The use of epidural bupivacaine following total knee arthroplasty. Orthop Rev 1989;18:894–901.
  4. Kalso E, Tramer MR, Carroll D, et al. Pain relief from intraarticular morphine after knee surgery: a qualitative systematic review. Pain 1997;71(2):127–134. DOI: 10.1016/S0304-3959(97)03344-7.
  5. Forst J, Wolff S, Thamm P, et al. Pain therapy following joint arthroplasty. a randomized study of patient-controlled analgesia versus conventional pain therapy. Arch Orthop Trauma Surg 1999;119(5-6):267–270. DOI: 10.1007/s004020050407.
  6. Strassels SA, Chen C, Carr DB. Postoperative analgesia: economics, resource use, and patient satisfaction in an urban teaching hospital. Anesth Analg 2002;94(1):130–137. DOI: 10.1213/00000539-200201000-00025.
  7. Pasero C, Paice JA, McCaffery M. Basic mechanisms underlying the causes and effects of pain. In: McCaffery M, Pasero C, ed. Pain: clinical manual. 2nd ed., St. Louis, MO: Mosby; 1999. pp. 15–34.
  8. Bourne RB, Chesworth B, Davis A, et al. Comparing patient outcomes after THA and TKA: is there a difference? Clin Orthop Relat Res 2010;468(2):542–546. DOI: 10.1007/s11999-009-1046-9.
  9. Kim SJ, Bamne A, Song YD, et al. Patients still wish for key improvements after total knee arthroplasty. Knee Surg Relat Res 2015;27(1):24–33. DOI: 10.5792/ksrr.2015.27.1.24.
  10. Badner NH, Bourne RB, Rorabeck CH, et al. Intra-articular injection of bupivacaine in knee-arthroplasty operations. Results of use for analgesia and for pre-emptive blockade. J Bone Joint Surg Am 1996;78(5):734–738. DOI: 10.2106/00004623-199605000-00013.
  11. Estebe JP, Kerebel C, Brice C, et al. Pain and tourniquet in orthopaedic surgery. Cah Anesthesiol 1995;43:573–578.
  12. Vendittoli PA, Makinen P, Drolet P, et al. A multimodal analgesia protocol for total knee arthroplasty: a randomized, controlled study. J Bone Joint Surg Am 2006;88(2):282–289. DOI: 10.2106/00004623-200602000-00005.
  13. Stein C. The control of pain in peripheral tissue by opioids. N Engl J Med 1995;332(25):1685–1690. DOI: 10.1056/NEJM199506223322506.
  14. Stein C. Peripheral mechanisms of opioid analgesia. Anesth Analg 1993;76(1):182–191. DOI: 10.1213/00000539-199301000- 00031.
  15. Lombardi Jr AV, Berend KR, Mallory TH, et al. Soft-tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res 2004;428:125–130. DOI: 10.1097/01.blo.0000147701.24029.cc.
  16. Ritter MA, Koehler M, Keating EM, et al. Intra-articular morphine and/or bupivacaine after total knee arthroplasty. J Bone Joint Surg Br 1999;81(2):301–303. DOI: 10.1302/0301-620X.81B2.0810301.
  17. Browne C, Copp S, Reden L, et al. Bupivacaine bolus injection versus placebo for pain management following total knee arthroplasty. J Arthroplasty 2004;19(3):377–380. DOI: 10.1016/j.arth.2003.10.012.
  18. Rasmussen S, Kramhøft MU, Sperling KP, et al. Increased flexion and reduced hospital stay with continuous intraarticular morphine and ropivacaine after primary total knee arthroplasty: open intervention study of efficacy and safety in 154 patients. Acta Orthop Scand 2004;75(5):606–609. DOI: 10.1080/00016470410001501.
  19. Feldman HS. Toxicity of local anaesthetic agents. In: Rice SA, Fish KJ, ed. Anesthetic Toxicity. New York: Raven Press; 1994. pp 107–133.
  20. Martinsson T, Haegerstrand A, Dalsgaard CJ. Effects of ropivacaine on eicosanoid release from human granulocytes and endothelial cells in vitro. Inflamm Res 1997;46(10):398–403. DOI: 10.1007/s000110050210.
  21. Crowley C, Dowsey MM, Quinn C, et al. Impact of regional and local anaesthetics on length of stay in knee arthroplasty. ANZ J Surg 2012;82(4):207–214. DOI: 10.1111/j.1445-2197.2011.05991.x.
  22. Maheshwari AV, 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):1418–1423. DOI: 10.1007/s11999-009-0728-7.
  23. Mullaji Arun. Efficacy of periarticular injection of bupivacaine, fentanyl, and methylprednisolone in total knee arthroplasty - a prospective, randomized trial. J Arthroplasty 2010;25(6):851–857. DOI: 10.1016/j.arth.2009.09.007.
  24. Busch CA, Shore BJ, Bhandari R. Efficacy of periarticular multimodal drug injection in total knee arthroplasty - a randomized trial. J Bone Joint Surg Am 2006;88(5):959–963. DOI: 10.2106/00004623-200605000-00005.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.