Periarticular analgesia vs epidural analgesia in early post operative period of total knee arthroplasty

Abstract

Modern view of perioperative pain is to view it as an impediment to recovery and various methods are used to facilitate rapid return to normal functional activity. Post operative pain relief after knee surgeries, especially total knee replacement, is a major concern. It is severe in 60% of patients and moderate in 30%. It causes undue distress and hinders early intense physical therapy, considered one of the most important factors for optimal postoperative knee rehabilitation. The present study compares the efficacy between periarticular cocktail and epidural analgesia in early post operative pain management following TKA. A total of 78 patients were included in the study. By simple randomization patients were divided into Group A in which 48 patients received a periarticular cocktail and Group B in which 30 patients received Epidural top up dose. Group -A patients received an analgesic cocktail of 0.125% Bupivacaine (2mg/kg body weight), Ketorolac (30mg), Adrenaline. This analgesic cocktail of 20 cc was infiltrated in the posterior capsule, medial structure, lateral structures and the cut quadriceps tendon before placing the implant. Epidural topup of 8cc of 0.125% Bupivacaine was given 6 hours after surgery in Group B patients. No drain was placed in patients of Periarticular infiltration group. A straight leg raise test was done to assess the VAS score at 12h, 24h, 48h, 72h. Epidural analgesia provides effective pain control despite the disadvantages of its invasiveness, late return of motor functions and more systemic side effects. Local infiltrative periarticular analgesia methods should be considered due to its ease of use, lower rates of systemic side effects and the fact that it does not extend the motor block or require systemic application of LA, while providing comparable pain relief and equal range of movements and ambulation in the immediate postoperative period