scholarly journals Percutaneous periarticular analgesic injection at one day after simultaneous bilateral total knee arthroplasty: an open-label randomized control trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takuya Iseki ◽  
Sachiyuki Tsukada ◽  
Motohiro Wakui ◽  
Kenji Kurosaka ◽  
Shinichi Yoshiya ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Medical Information ◽  
University Hospital ◽  
Open Label ◽  
Periarticular Injection ◽  
Injection Group ◽  
Total Knee ◽  
Simultaneous Bilateral Tka

Abstract Background The postoperative pain after total knee arthroplasty (TKA) remains a critical issue. The aim of this study was to assess the clinical effectiveness of percutaneous periarticular injection at 1 day following simultaneous bilateral TKA. Methods A total of 88 knees in 44 patients who underwent simultaneous bilateral TKA were randomly assigned to receive a percutaneous periarticular injection at 1 day following surgery (n = 22 patients) or no injection (n = 22 patients). In the additional injection group, we injected a solution including methylprednisolone, ropivacaine, and epinephrine into the muscle belly of the vastus medialis at 1 day after surgery. In both groups, patients received an intraoperative periarticular multi-drug injection and postoperative intravenous and oral nonsteroidal anti-inflammatory drugs. The primary outcome measure was the postoperative pain at rest using a visual analog scale (VAS) and analyzed with Student’s t test. Results Compared to the no additional injection group, the additional periarticular injection group had significantly lower VAS score at 8:00 PM postoperative day 1, 6:00 AM postoperative day 2, 12:00 PM postoperative day 2, 6:00 AM postoperative day 5, 12:00 PM postoperative day 5, and 8:00 PM postoperative day 5 (p < 0.05). The rate of complication did not differ between groups (p > 0.05). Conclusion Additional percutaneous periarticular injection at 1 day following TKA adding to intraoperative periarticular injection provided better postoperative pain relief. Trial registration Registered at the University Hospital Medical Information Network (registration number: UMIN000029759).

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.

scholarly journals Intra-articular tranexamic acid as an adjunct to intravenous tranexamic acid for simultaneous bilateral total knee arthroplasty: a randomized double-blind, placebo-controlled trial

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Sachiyuki Tsukada ◽  
Kenji Kurosaka ◽  
Masahiro Nishino ◽  
Tetsuyuki Maeda ◽  
Yoshiharu Yonekawa ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
University Hospital ◽  
Allogenic Blood Transfusion ◽  
Allogenic Blood ◽  
Perioperative Blood Loss ◽  
Total Knee ◽  
Simultaneous Bilateral Tka

Abstract Background Intra-articular tranexamic acid (TXA) as an adjunct to intravenous TXA was reported to decrease perioperative blood loss during unilateral total knee arthroplasty (TKA). However, there have been no randomized controlled trials comparing intravenous versus combined intravenous and intra-articular TXA administration in patients undergoing simultaneous bilateral TKA. Methods We randomly assigned 77 patients with 154 involved knees undergoing simultaneous bilateral TKA to the intravenous TXA group (intra-articular placebo for each knee) or combined TXA group (1000 mg of intra-articular TXA for each knee) with 1:1 treatment allocation. In both groups, 1000 mg of TXA was given intravenously twice, just before surgery and 6 h after the initial administration. Other perioperative medications, surgical procedures, and blood management strategies were the same for all patients. The primary outcome was perioperative blood loss calculated from blood volume and change in hemoglobin from preoperative to postoperative day 3. Results Intention-to-treat analysis showed no statistically significant differences in perioperative blood loss until postoperative day 3 (1067 ± 403 mL in the intravenous TXA group vs. 997 ± 345 mL in the combined TXA group [95% CI, − 240 to 100 mL], P = 0.42). No patients required allogenic blood transfusion. The incidence of thrombotic events did not differ between groups (12% in the intravenous TXA group vs. 9% in the combined TXA group; P = 0.73). Conclusions The addition of intra-articular TXA did not reduce perioperative blood loss in patients undergoing simultaneous bilateral TKA compared with placebo. Trial registration University Hospital Medical Information Network UMIN000026137. Registered 14 February 2017.

scholarly journals Effectiveness of Periarticular Infiltration of the Knee during Total Knee Arthroplasty for Postoperative Pain Management

2021 ◽  
Vol 3 (2) ◽  
pp. 24-28
Author(s):  
Bibhuti Nath Mishra ◽  
Joydeep Banerjee Chowdhury ◽  
Rajeev Raman ◽  
Dipmalya Chakraborty ◽  
Tanmoy Karmakar
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Periarticular Injection ◽  
Combination Drugs ◽  
Total Knee ◽  
Periarticular Infiltration

Background: Different treatment regimens of analgesia, nerve blocks and epidurals are used for pain relief in Total Knee Arthroplasty (TKA). Local infiltration analgesia (LIA) is one of the modalities in which a cocktail combination of different medicines is infiltrated locally into the capsule, surrounding tissues or intraarticular joint space. This study aims to analyze the effectiveness of periarticular injection of combination drugs (Bupivacaine, Ketorolac and Morphine) during TKA for postoperative pain management. Methods: Total of 150 patients who underwent primary unilateral TKA were randomly categorized into 2 groups (75 each). Group A (control group) didn’t receive intraoperative periarticular injection but Group-B received the intraoperative injection of combined local analgesics and anaesthetics (Bupivacaine, Ketorolac and Morphine). Pain following surgery at 0, 1, and 2 postoperative days were recorded with visual analogue scale (VAS) whereas Knee Society Score was used to evaluate the pain and function pre-operative and 3 months’ post-operative. Statistical analysis was done using SPSS software. Results: Patients receiving periarticular infiltration of combination drugs intraoperatively had lower VAS for postoperative pain (p < 0.001) and this group also showed reduced need of analgesia postoperatively. Conclusions: Periarticular infiltration of knee during Total Knee Arthroplasty is effective in management of postoperative pain Keywords: Periarticular; Total Knee Arthroplasty; combination drugs; postoperative pain

Efficacy of Liposomal Bupivacaine Compared with Multimodal Periarticular Injections for Postoperative Pain Control following Total Knee Arthroplasty

2018 ◽  
Vol 32 (10) ◽  
pp. 979-983 ◽  
Author(s):  
Tyler Britten ◽  
Jonathan D. Hughes ◽  
Yolanda Munoz Maldonado ◽  
Kirby D. Hitt
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Wound Complications ◽  
Opioid Use ◽  
Liposomal Bupivacaine ◽  
Periarticular Injection ◽  
Pain Scores ◽  
Time Period ◽  
Total Knee

AbstractSingle-dose long-acting periarticular anesthetics have been shown to be an effective method of postoperative analgesia in total knee arthroplasty (TKA). This study retrospectively compares the efficacy of multimodal periarticular injection consisting of a combination of ropivacaine, duramorph, epinephrine, and toradol (HC) with liposomal bupivacaine (LB) periarticular injection in TKA. This study was a retrospective matched comparative chart review of two cohorts of patients who underwent TKA within a single health care system and cared for by one provider. We compared 22 patients who were treated with LB intraoperatively (LBG) with 41 matched controls who were treated with HC periarticular injection (HCG). These cases were retrospectively reviewed at 0 to 6, 6 to 12, 12 to 24, 24 to 48, and 48 to 72 hours. We reviewed pain scores and opioid use per the preceding time period, total opioid use, length of stay (LOS), and wound complications between the two groups. The two groups showed no statistical difference in total opioids used. In both the 6- to 12-hour and 12- to 24-hour intervals, the LBG required significantly more opioids than the HCG, with p-values of 0.0039 and 0.0061, respectively. Pain scores were not significantly different for any time period. We found no difference in LOS. The LBG tended to have lower doses of antiemetics than the HCG. No significant difference was found in postoperative pain scores and total opioid use between LB and multimodal periarticular intraoperative injections in TKA. Our data demonstrated decreased opioid consumption in the HC group compared with the LB group in both the 6- to 12-hour and 12- to 24-hour time intervals postoperatively. At our institution, LB costs US$314.99, whereas HC costs US$95.

scholarly journals Effects of preoperative, scheduled administration of antiemetics on reducing postoperative nausea and vomiting in patients undergoing total knee arthroplasty

2019 ◽  
Author(s):  
Moon Jong Chang ◽  
Chong Bum Chang ◽  
Seung-Baik Kang ◽  
Hyung Jun Park ◽  
Keum Min Hwang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Post Injection ◽  
Antiemetic Drug ◽  
Injection Group ◽  
Total Knee ◽  
Postoperative Administration

Abstract Background To date, there has been no established protocol regarding the timing of the scheduled administration of antiemetics in total knee arthroplasty (TKA). Previous prospective studies analyzing the scheduled use of antiemetics differed in the timing at which the drugs were administered. However, antiemetic drugs are not administered post-operatively until noxious stimuli caused by drugs used during anesthesia and operative procedures. The purpose of this study was 1) to determine whether preoperative scheduled administration of an antiemetic drug can reduce iatrogenic postoperative nausea and vomiting (PONV) in TKA compared to postoperative administration, and 2) to determine whether there was a difference in postoperative pain, patient satisfaction, and complications after TKA between pre- and postoperative administrations.Methods This retrospective study included patients who were assigned to either intravenous administration of the antiemetic drug (ramosetron) 1 hour before surgery (pre-injection group: 50 patients) or at the end of surgery (post-injection group: 51 patients). The incidence of PONV and the frequency of rescue medicine use were recorded until 48 hours postoperation. Postoperative pain level and satisfaction were also assessed using the visual analogue scale (VAS). Possible complications associated with serotonin receptor antagonists; for example, headaches, dizziness, and drowsiness were also assessed.Results The incidence of nausea events was lower in the pre-injection group than in the post-injection group. However, there was no difference between the two groups in terms of frequency of vomiting events and the use of rescue medicine for PONV. Also, postoperative pain, satisfaction scores, and incidence of complications were not different between the two groups.Conclusions The patients with preoperative scheduled administration of antiemetics showed lower incidence of nausea events than those with postoperative administration. However, it is difficult to conclude that the extent of the effect was clinically significant. Further research is needed to determine the optimal timing and method for more effective antiemetic treatment.

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.

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