The Effect of Intraoperative Periarticular Local Injection in Total Knee Arthroplasty

Abstract

Purpose: To assess the effect of intraoperative periarticular local injection in total knee arthroplasty. Materials and Methods: We studied 36 patients (72 knees) that underwent bilateral simultaneous primary total knee replacement between October, 2005 and December, 2006. The study group (36 ipsilateral knees) received a 60 ml intraoperative periarticular injection containing a mixture of bupivacaine, epinephrine, morphine, ketorolac, and saline. The injection was made in the posterior capsule and surrounding soft tissues, muscles, and subcutaneous tissues. The control group (36 contralateral knees) did not receive this injection. Postoperative pain levels were evaluated at 2, 8, 24, 48, and 72 hours and 7 and 14 days using the Visual Analogue Scale (VAS). Hemo-vac drains were evaluated at postoperative days 1, 2, 3, 4, and 5. Results: There was no side-to-side difference of VAS in both the study group and the control group according to the side chosen. Preoperative VAS was not significantly different between the two groups. There was a significant decrease in the VAS of the study group patients at 2, 8, 24, 48, and 72 hours postoperative, with the most significant decrease seen at 2 hours. Postoperative bleeding was significantly lower in the study group on the first day, with no difference seen thereafter between the two groups. Conclusion: Intraoperative periarticular local injection provides better immediate postoperative pain control in total knee arthroplasty.