Abstract
BackgroundGiven no consensus on optimal timeframe of periarticular multimodal drug injection (PMDI) in knee osteoarthritis patients undergoing total knee arthroplasty (TKA), this study was aimed to compare the postoperative pain and the functional recovery in patients who underwent simultaneous bilateral TKA (SBTKA) and received PMDI at the different intraoperative time points.MethodsThis prospective, randomized, double-blinded controlled trial study included 48 patients who underwent SBTKA and received PMDI mixture, either before prosthetic implantation (late PMDI), or just after knee arthrotomy (early PMDI). Each subject’s knees were randomly selected to different PMDI administration time points. The outcome parameters were postoperative pain assessed by using a visual analog scale (VAS), the maximal angle of knee flexion, and quadriceps function from day 1 to 6 weeks after surgery.ResultsLate PMDI revealed slightly higher VAS at 6 and 12 h after the operation than early PMDI administration. Afterward, the VAS tended to be lower in the late than early PMDI administration until the end of the study, but without statistical significance. The time difference between early and late PMDI had no effect on postoperative VAS, while older age resulted in significantly less pain. No statistical differences between the two groups in all other outcome parameters were observed.ConclusionsPostoperative pain reduction and functional recovery of SBTKA with early and late PMDI administration were not significantly different. The time interval of PMDI between knees did not confound the comparison of postoperative pain and functional recovery in SBTKA.Trial registrationThe protocol of this study was retrospectively registered in the Thai Clinical Trials Registry database No.TCTR20170617001 on 16 June 2017.
Highlights
Given no consensus on optimal timeframe of periarticular multimodal drug injection (PMDI) in knee osteoarthritis patients undergoing total knee arthroplasty (TKA), this study was aimed to compare the postoperative pain and the functional recovery in patients who underwent simultaneous bilateral TKA (SBTKA) and received PMDI at the different intraoperative time points
Previous literature reported the incidence of moderate-to-severe pain after TKA at 30 days following surgery was about 50% and approximately 20% of the patients were dissatisfied with the outcomes following the operation [3, 4]
Identical rehabilitation protocol was administered for all patients including a continuous passive motion (CPM) device applied on the day after surgery, and walking with a walker was allowed on day 2 postoperatively
Summary
Given no consensus on optimal timeframe of periarticular multimodal drug injection (PMDI) in knee osteoarthritis patients undergoing total knee arthroplasty (TKA), this study was aimed to compare the postoperative pain and the functional recovery in patients who underwent simultaneous bilateral TKA (SBTKA) and received PMDI at the different intraoperative time points. Exaggerated pain response following TKA is caused by both peripheral and central sensitization, which may persist up to 3 months after surgery [9]. Prevention of hyperexcitability stage of peripheral and central nociceptors is a principle of preemptive analgesia that could reduce amplification of postoperative pain [3, 5, 10]. Strategies that provide an adequate blockade to prevent neural hypersensitization and extend the effect during the inflammatory response in the early postoperative period are necessary [11, 12], and the multimodal pain management that consists of preemptive, perioperative, and postoperative analgesia is widely accepted for its efficacy in postoperative pain control [13]
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