Abstract
Objectives: To evaluate the postoperative analgesic yield of continuous intra-articular (IA) ropivacaine/tramadol infusion as against infusion of ropivacaine alone after total knee arthroplasty. Patients and Methods: Sixty patients accompanied by arthrosis were randomly divided into three equal groups: The ropivacaine group, which obtained a continuous intraarticular (IA) infusion of ropivacaine alone; the combination group, which obtained a continuous (IA) infusion of a combination of ropivacaine and tramadol at a rate of 6 ml/h for 72 h postoperatively; and the control group, which did not receive IA medications. After release of the ischemic tourniquet and assurance of haemostasis, a vacuum drainage tube was applied. The (IA) infusion was delivered through a multipored catheter for 72 h. Postoperative pain was assessed using visual analogue pain scale (VAS), and intravenous meperidine was administered as rescue analgesia if the (VAS) pain score was greater than or equal to (4) or on patient’s request. The total rescue analgesia consumption, angle of flexion of the knee and hospital stay were recorded. Results: The ability to achieve better angle of flexion was significantly higher in the combination group compared with the other groups, with a significant difference in favour of the ropivacaine group compared with the control group. At 2 h postoperatively, the mean pain (VAS) scores were significantly lower in patients who received (IA) analgesia compared with the control group and in the ropivacaine/tramadol group versus the ropivacaine group. The number of requests and total dose of rescue analgesia consumed were significantly lower with (IA) analgesia, with a significant difference in favour of the combination group. There was significant correlation between pain (VAS) scores and angle of flexion of the knee joint. Conclusion: Continuous (IA) ropivacaine/tramadol infusion safely reduced postoperative pain and spared administration of rescue analgesics with a significantly improved range of joint movement.
Highlights
Arthroplasty surgeries carry multiple concerns for both surgeons and anaesthetists
The angle of knee joint movement was significantly (P < 0.05) better in the combination group compared with the other groups, with a significantly wider scale of motion in the ropivacaine group compared with the control group (Table 2) (Figure 2)
At time zero (2 h postoperatively) for first evaluation of the pain visual analogue pain scale (VAS) score, the mean pain VAS score was significantly lower in patients who received intrarticular analgesia compared with the control group, with significantly lower scores in favour of the combination group
Summary
Patients who need arthroplasty surgeries are usually geriatric patients who are handicapped or immobilized or who have been suffering from slow painful motion since years. These patients mostly have additional morbidities, which may delay their postoperative recovery [1]. Multiple analgesic modalities were proposed for management of postoperative pain in patients undergoing arthroplastic surgery. Remeand et al [3] reported that intravenous ketamine had a morphine-sparing effect after total hip arthroplasty, facilitated rehabilitation at 1 month, and decreased postoperative chronic pain up to 6 months after surgery. Other studies tried the use of various intra-articular medications for pain management after arthroplastic surgeries
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
