Efficacy of Intraoperative Periarticular Local Infiltration for Pain Control and Ambulation in Total Knee Arthroplasty: A Randomized Case-Control Study.

Abstract

Total knee arthroplasty (TKA) is a leading operative procedure for late-stage knee osteoarthritis. The cornerstone of a successful TKA is swift and effective rehabilitation to achieve a pain-free and good range of motion. Pain post-replacement hinders an effective rehabilitation protocol. Reported preoperative, perioperative, and postoperative analgesia modes have undesirable side effects. The purpose of this study is to assess the effect of a unique cocktail injection on immediate postoperative pain using the visual analog score, the need for additional analgesics during the initial period, and the ambulation time between the case and control groups. In this randomized case-control study, the periarticular injection consisted of ropivacaine 0.75mg/ml (28ml), epinephrine 1mg/ml (0.5ml), and ketorolac 30mg/ml (1ml) added to 50ml of normal saline to make 80 ml of solution. Fifty patients were chosen and randomly divided into two groups of 25 each by computer-generated randomization. The case group received the cocktail injection, and the control group was injected locally with normal saline. Visual analog scale (VAS) was assessed at 3, 6, 12, and 24hr post-surgery, and the amount of additional analgesics used and ambulation time were assessed. A total of 50 patients who underwent TKA were selected and divided into case and control groups of 25 each. The majority of the patients had osteoarthritis, and a few had rheumatoid arthritis. No significant differences in demographic data (age, gender, body-mass index) or surgical time. The case group had excellentVAS scores between 0 and 3 at 3, 6, 12, and 24hr (p < .001). The amount of additional analgesia required in the case group was minimal (<3 doses) in 96% of the patients on Day1. More than 80% of patients could ambulate pain-free on Day1. Pain reduction with early ambulation was noted in a significant number of individuals with the use of this unique intraoperative local cocktail injection. This pain-free initial period following TKA prepared patients for an effective rehabilitation program.