scholarly journals Side-Effect Profiles And Efficacy Of Low Dose Intrathecal Morphine Combine With Periarticular Injection In Elective Primary Unilateral Total Knee Arthroplasty

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0009
Author(s):  
Chompunoot Pathonsamit ◽  
Pruk Chaiyakit ◽  
Ittiwat Onklin
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Side Effect ◽  
Pain Control ◽  
Intrathecal Morphine ◽  
Postoperative Pain Control ◽  
Periarticular Injection ◽  
Total Knee

Background: Total knee arthroplasty (TKA) is concerned as a severe postoperative pain procedure. Intrathecal morphine provides good analgesia but has many side effects such as nausea, vomiting, pruritus and respiratory depression. Appropriate postoperative pain control strategy with lower side effect is still challenging. We combined periarticular injection(PI) as a multimodal analgesia with intrathecal morphine in order to decrease intrathecal morphine dosage and lower side effects. Objective: To determine side-effect profiles and efficacy of 0.1 mg and 0.2 mg intrathecal morphine combine with PI in primary unilateral TKA. Material and method: In this prospective, double-blinded, randomized controlled trial. Patients undergoing TKA were recruited from April 2018 to April 2019. All patients were randomized into 3 groups. M 0 (n=32), M 1 (n=36)and M 2 (n=34) represent no intrathecal morphine, 0.1 mg and 0.2 mg intrathecal morphine respectively. All Group received same regimen of PI as a multimodal analgesia and same postoperative pain control protocol. Results: Patients in group M 2 had more nausea or vomiting side effects compared to group M 1 in early postoperative 4 hours(77.1% and 51.4%) with statistical significant(p<0.05) and also required 2 antiemetic drug to relieve symptoms (4.7% and 2.3%) with statistical significant ( p<0.05). No difference in postoperative pain score, rescue analgesic drug consumption ,pruritic score, sedation score, respiratory depression and orthopedic outcomes such as straight leg rising time and maximum active knee flexion between M 1 and M 2 groups. Conclusion: Lower intrathecal morphine dosage (0.1 mg) combine with periarticular injection in primary unilateral total knee arthroplasty provide similar postoperative pain control as standard intrathecal morphine dosage(0.2 mg) combine with periarticular injection with lower rates and severities of nausea and vomiting in first postoperative 4 hours.

Periarticular Injection of Ketorolac Augmenting Intravenous Administration of Ketorolac for Postoperative Pain Control: A Randomized Controlled Trial in Simultaneous Bilateral Total Knee Arthroplasty

2020 ◽  
Author(s):  
Artit Laoruengthana ◽  
Piti Rattanaprichavej ◽  
Akaworn Mahatthanatrakul ◽  
Thanawat Tantimethanon ◽  
Manupat Lohitnavy ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Intravenous Administration ◽  
Knee Arthroplasty ◽  
Analgesic Effect ◽  
Pain Control ◽  
Local Concentration ◽  
Postoperative Pain Control ◽  
Periarticular Injection ◽  
Total Knee

AbstractAdequate postoperative pain control with minimal side effects is necessary for patients undergoing total knee arthroplasty (TKA). Ketorolac is a frequently used nonsteroidal anti-inflammatory drug due to its excellent disposition in all administration routes; however, it possesses an “analgesic ceiling,” which means that higher doses of the drug have no additional analgesic effect. Alternatively, increasing the local concentration of ketorolac via periarticular injection may provide additional pain relief to parenteral administration of ketorolac, but evidence demonstrating the benefits and safety of this approach is limited. Therefore, this study assesses whether local ketorolac injection could yield additional pain reduction to intravenous administration of ketorolac. A total of 54 patients who underwent simultaneous bilateral TKA were enrolled. Randomization was performed to determine whether 50 mg of bupivacaine plus 30 mg of ketorolac (ketorolac group), or only 50 mg bupivacaine (bupivacaine group) would be periarticularly injected into the first knee operated on (more painful), and then the contralateral knee would receive another mixture. Ketorolac (30 mg) was intravenously given every 8 hours for the first 48 hours. Visual analog scales (VASs) were used to assess pain, knee recovery function, and patients' preferred knee. Postoperative VAS pain scores in the ketorolac group were lower than those in the bupivacaine group 6 to 96 hours postoperatively and reached statistical significance 12 (4.25 ± 2.38 vs. 5.06 ± 2.48, respectively; p = 0.04) and 24 hours (4.22 ± 1.94 vs. 5.30 ± 2.12, respectively; p < 0.01) postoperatively. The ketorolac group had higher degrees of knee flexion and straight leg raise. No patient experienced adverse effects of ketorolac. On the day of discharge, 61.11% of the patients favored the knee that received local ketorolac injection (p < 0.01). Adjunct local ketorolac injection to systemic administration is well tolerated and may improve its analgesic effect as determined by the patients' perception.

scholarly journals Efficacy of duloxetine compared with opioid for postoperative pain control following total knee arthroplasty

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253641
Author(s):  
Man Soo Kim ◽  
In Jun Koh ◽  
Keun Young Choi ◽  
Sung Cheol Yang ◽  
Yong In
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Pain Control ◽  
Readmission Rate ◽  
Postoperative Pain Control ◽  
Vas Score ◽  
Total Knee ◽  
One Year

Background The purpose of this study was to assess the efficacy of duloxetine as an alternative to opioid treatment for postoperative pain management following total knee arthroplasty (TKA). Methods Among 944 patients, 290 (30.7%) of patients received opioid or duloxetine for pain control for 6 weeks when the pain Visual Analogue Scale (VAS) score was greater than 4 out of 10 at the time of discharge. 121 patients in the Opioid group and 118 in the Duloxetine group were followed up for more than one year. Preoperative and postoperative patient reported outcome measures (pain VAS score, Western Ontario and McMaster Universities OA Index (WOMAC) score were compared. The rate of further drug prescription (opioid or duloxetine) after 6 weeks of first prescription, 30-day readmission rate, and side effects were also investigated. Results There was no significant difference in pain VAS score, WOMAC Pain and Function score, at each time point between before and after surgery (all p>0.05). Fifteen (9.8%) patients in the opioid group and six (4.4%) patients in the duloxetine group were prescribed additional medication after first 6 weeks, showing no significant (p>0.05) difference in proportion. The 30-day readmission rate and the incidence of side effects were also similar (all p>0.05). There was no difference in the incidence of side effects between the two groups (p>0.05). Conclusion Duloxetine and opioid did not show any difference in pain control, function, and side effects for up to one year after TKA. Although large-scale randomized controlled trials are still required to further confirm the side effects of duloxetine, it can be considered as an alternative to opioid for postoperative pain control following TKA.

Comparative study between: Epidural bupivacaine versus Patient Controlled Analgesia for postoperative pain control in total knee arthroplasty

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A T A Elkhouly ◽  
M A Bassiony ◽  
M M N Elshafey ◽  
K M Khalaf ◽  
A M Alansary
Keyword(s):  
Total Knee Arthroplasty ◽  
Stress Response ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Pain Control ◽  
Patient Controlled Analgesia ◽  
Postoperative Pain Control ◽  
Epidural Bupivacaine ◽  
Total Knee ◽  
Cortisol Levels

Abstract Introduction Effective postoperative pain control in total knee arthroplasty is important, especially with starting physiotherapy and early ambulation, which enhances recovery and reduces hospital length of stay. The risk of postoperative complications, such as deep venous thrombosis and nosocomial infections, has also been shown to decrease with early mobilization. Aim The aim of this study is to assess the analgesic efficacy of epidural bupivacaine compared with intravenous patient controlled analgesia (opioid and NSAIDs) during postoperative period in total knee arthroplasty. Patients Forty patients, ranging in age from 20 to 70 yr, scheduled to receive total knee replacements with spinal anesthesia were randomly assigned to this study. Methods patients received epidural bupivacaine 0.125% alone in (group epa) or iv nalbuphine 50mg, ketorolac 60mg via pca device. The quality of postoperative analgesia was assessed by the anesthesiologist according to Visual Analogue Score (VAS), Cortisol level 24 hours preoperative and 2 hours postoperative for stress response. Results The efficacy of both epidural Bupivacaine and i.v nalbuphine & ketorolac via PCA device in controlling pain after total Knee arthroplasty however PCA was slightly less efficient especialy during the 12 hr after surgery. We found that one of the main draw backs of epidural analgesia using bupivacaine were arterial hypotension and urinary retention which required catheterization of many patients for voiding of urine. Results were comparable between the 2 groups and were against group EPA, Serum cortisol levels were elevated 2h post-surgery in all patients. This elevation is in accordance with the well-established stress response to surgery. Furthermore, cortisol levels were significantly less elevated in the group EPA, compared with group PCA. Conclusion The results of the study revealed both Epidural bupivacaine and systemic opioids combined with NASID via PCA device are effective of pain control post TKA.

scholarly journals Intraarticular Pain Catheter Is Not a Necessary Modality for Postoperative Pain Control After Total Knee Arthroplasty

2021 ◽  
Vol 7 ◽  
pp. 43-46
Author(s):  
Wolfgang Fitz ◽  
Paul M. Lichstein ◽  
Sarah Trainor ◽  
Jamie Collins ◽  
Caleb M. Yeung ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Pain Control ◽  
Postoperative Pain Control ◽  
Total Knee ◽  
Pain Catheter
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