Periarticular Injection Research Articles

Perioperative interventions to improve early mobilisation and physical function after hip fracture: a systematic review and meta-analysis.

Perioperative interventions could enhance early mobilisation and physical function after hip fracture surgery. Determine the effectiveness of perioperative interventions on early mobilisation and physical function after hip fracture. Ovid MEDLINE, CINAHL, Embase, Scopus and Web of Science were searched from January 2000 to March 2022. English language experimental and quasi-experimental studies were included if patients were hospitalised for a fractured proximal femur with a mean age 65years or older and reported measures of early mobilisation and physical function during the acute hospital admission. Data were pooled using a random effect meta-analysis. Twenty-eight studies were included from 1,327 citations. Studies were conducted in 26 countries on 8,192 participants with a mean age of 80years. Pathways and models of care may provide a small increase in early mobilisation (standardised mean difference [SMD]: 0.20, 95% confidence interval [CI]: 0.01-0.39, I2= 73%) and physical function (SMD: 0.07, 95% CI 0.00 to 0.15, I2= 0%) and transcutaneous electrical nerve stimulation analgesia may provide a moderate improvement in function (SMD: 0.65, 95% CI: 0.24-1.05, I2= 96%). The benefit of pre-operative mobilisation, multidisciplinary rehabilitation, recumbent cycling and clinical supervision on mobilisation and function remains uncertain. Evidence of no effect on mobilisation or function was identified for pre-emptive analgesia, intraoperative periarticular injections, continuous postoperative epidural infusion analgesia, occupational therapy training or nutritional supplements. Perioperative interventions may improve early mobilisation and physical function after hip fracture surgery. Future studies are needed to model the causal mechanisms of perioperative interventions on mobilisation and function after hip fracture.

Evaluation of a blind technique for peri-articular injection in patients with lumbar facet syndrome: a retrospective study

Evaluation of a blind technique for peri-articular injection in patients with lumbar facet syndrome: a retrospective study

Comparison of the effects of botulinum toxin type A hamstring muscle injection combined with periarticular injection and simple periarticular injection on early pain and functional recovery after total knee arthroplasty

Objective: This study was designed to compare the effects of hamstring muscle injection of botulinum toxin type A (BoNT/A) combined with periarticular injection to those of simple periarticular injection alone, in terms of early pain reduction and functional recovery following total knee arthroplasty (TKA).
 Methods: This study included 40 patients who underwent elective unilateral TKA at our hospital from February 2021 to December 2021. The patients were randomly assigned to either the experimental group (BoNT/A injection into the hamstring muscle + periarticular injection, n = 20 cases) or the control group (0.9% normal saline injection into the hamstring muscle + periarticular injection, n = 20 cases). The preoperative and postoperative 3-day HSS scores were compared between the two groups. Postoperative visual analog scale (VAS) pain scores were observed and compared between the two groups. The Lovett grading method was used to evaluate the postoperative muscle strength of both groups. Additionally, postoperative knee joint pain scores, maximum active flexion angle, and any postoperative adverse reactions were observed and compared between the two groups.
 Results: The experimental group showed significantly lower VAS pain scores than the control group at 24 h, 48 h, and 72 h after the operation, with a statistically significant difference (P < 0.05). Furthermore, compared to the control group, the patients in the experimental group exhibited larger knee joint active flexion angles at 1 day, 3 days, and 5 days post-operation, also demonstrating a statistically significant difference (P < 0.05). These findings hold scientific significance (P < 0.05). Additionally, the combined administration of BoNT/A hamstring muscle injection with periarticular injection exhibited a low incidence of adverse reactions during the perioperative period and had no significant effect on quadriceps muscle strength.
 Conclusion: The combination of BoNT/A hamstring muscle injection with periarticular injection effectively alleviates early postoperative pain following TKA and promotes early functional recovery of the knee joint.

How Effective Is Intrawound periarticular Cocktail Injection and Postoperative Intravenous Paracetamol for Analgesia and Early Mobilization after Total Knee Arthroplasty (TKA)

How Effective Is Intrawound periarticular Cocktail Injection and Postoperative Intravenous Paracetamol for Analgesia and Early Mobilization after Total Knee Arthroplasty (TKA)

Interscalene Block Versus Periarticular Liposomal Bupivacaine for Pain Control Following Reverse Shoulder Arthroplasty: A Randomized Trial.

Interscalene nerve blocks and local anesthetic infiltration are two methods commonly used in multimodal analgesia regimens for shoulder arthroplasty. Liposomal bupivacaine is a novel anesthetic that can be detected more than 24 hours following local administration. Studies comparing liposomal bupivacaine with conventional analgesic methods have found mixed results regarding pain and narcotic consumption, and there is little information available regarding patient satisfaction and the role of psychosocial variables. This is a randomized study of 76 adult patients undergoing reverse shoulder arthroplasty who were assigned to receive a preoperative interscalene nerve block with ropivacaine (BLOCK=38) or an intra-operative periarticular injection of liposomal bupivacaine (LOCAL=38). The primary outcomes were narcotic consumption (MEq, morphine equivalents), visual analog scale (VAS) pain scores, and satisfaction (0-10). The secondary outcomes were the effect of patient group preference (BLOCK vs LOCAL) and psychosocial variables (Pain Catastrophizing Scale, Brief Resilience Scale) on satisfaction. Length of stay, pain related phone calls, pain related readmissions, and the number of narcotic refills were tracked from the day of surgery through the first postoperative appointment, which was routinely 7-14 days following surgery. Intraoperative and day 0 narcotic consumption was lower in the BLOCK group by 17.3 and 21.6 MEq (p < 0.001, p = 0.035) with no differences on day 1 or 2. There was no difference in VAS pain scores, length of stay, pain related phone calls, pain related readmissions, or the number of narcotic refills. Patient satisfaction was higher in the BLOCK group [8.3 vs. 6.8, p = 0.017]. Pain catastrophizing, resilience, and patient group preference did not have any significant relationship with patient satisfaction. Patients undergoing reverse shoulder arthroplasty have higher satisfaction with a conventional interscalene block compared to a periarticular injection of liposomal bupivacaine. There were no clinically important differences in narcotic consumption, VAS pain scores, length of stay, pain related phone calls, pain related readmissions, or the number of narcotic refills. The Pain Catastrophizing Scale, Brief Resilience Scale, and patient preferences did not have any relationship with patient satisfaction.

Pain management following simultaneous bilateral total knee arthroplasty: genicular nerve blockade versus periarticular injection

The aim of the present study was to investigate whether the analgesic solution prepared for periarticular injection (PAI) could be utilized as a genicular nerve blockade (GNB) agent in bilateral knee arthroplasty, and to assess the pain control efficacy of this approach in comparison with PAI. This was a retrospective cohort in which patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were evaluated. Thirty patients were enrolled. The standard PAI was used for one knee, while the PAI solution was applied in the form of GNB to the other. Visual Analog Scale (VAS) pain scores were measured and recorded separately for each knee, at rest (static) and during exercise (dynamic). Active range of joint motion (JRM) for both knee joints was measured preoperatively, at postoperatively. Compared to the PAI group, the GNB group had lower VAS scores at 2 and 8 hours (p = 0.030 and p &lt; 0.001, respectively). The GNB group also had lower dynamic VAS scores at 2, 8, and 24 hours (p = 0.009, p &lt;0.001 and p&lt;0.001, respectively). Static and dynamic VAS measurements did not demonstrate any differences between groups (GNB vs. PAI) at 48 hours and 30 days (p&gt;0.05). When the reduction in VAS scores was assessed, we found that the decrease in both scores was significantly greater in the PAI group compared to the GNB group (p&lt;0.001, for both). There were no significant differences between the groups with regard to drainage volume, complications and JRM (p&gt;0.05). GNB was found to be more effective for pain control throughout the first postoperative day in patients who underwent simultaneous bilateral TKA.

Periarticular Injection In Addition To Interscalene Nerve Block Can Decrease Opioid Consumption And Pain Following Total Shoulder Arthroplasty: A Prospective Comparison Cohort Study.

Periarticular Injection In Addition To Interscalene Nerve Block Can Decrease Opioid Consumption And Pain Following Total Shoulder Arthroplasty: A Prospective Comparison Cohort Study.

Periarticular Injection vs Peripheral Nerve Blockade in Bilateral Total Hip Arthroplasty

Periarticular Injection vs Peripheral Nerve Blockade in Bilateral Total Hip Arthroplasty

Periarticular Injection in Total Knee Arthroplasty.

Optimal pain management after total knee arthroplasty (TKA) can expedite postoperative recovery, improve perioperative outcomes, and increase patient satisfaction. Periarticular injections (PAIs) have become increasingly used to improve pain management after TKA. Similar to peripheral nerve blocks, the use of intraoperative PAIs can lower pain scores and expedite discharge from the hospital. However, there is notable variability in the ingredients and administration techniques of PAIs. Currently, no standard of care exists for PAIs, especially in the setting of adjuvant peripheral nerve blocks. This study seeks to evaluate the ingredients, administration techniques, and outcomes of PAIs used during TKA.

Comparison of Dextrose Prolotherapy and Triamcinolone Intraarticular Injection on Pain and Function in Patients with Knee Osteoarthritis - A Randomized Clinical Trial.

The present study was performed to assess the therapeutic effects of combined intra and extraarticular dextrose prolotherapy on knee osteoarthritis and its comparison with intra- articular triamcinolone injection. In this study, 50 patients suffering from knee osteoarthritis were allocated into two groups as a double-blind randomized clinical trial. The first group received one session of dextrose prolotherapy as one intra-articular injection of 10cc dextrose 16% and periarticular intradermal injections of dextrose 12% at 4 points around the knee (2.5 cc at each point). The second group underwent therapy with one intra-articular injection of triamcinolone (40 mg). Compared to pretreatment, both interventions caused significant improvement in pain (evaluated by VAS) and WOMAC (all its components) in 1 and 3 months postintervention (all with P-value < 0.005). In the first month, pain reduction was significantly better in corticosteroid group (P-Value 0.002 and 0.048 respectively). In third month post intervention, improvements in VAS and WOMAC components were significantly greater in prolotherapy group. Both methods of corticosteroid and dextrose prolotherapy (combined intra and extraarticular technique) are effective on pain and function of patients with knee osteoarthritis. Compared to corticosteroid, prolotherapy method was associated with less pain reduction in short- term, but its effects were more persistent and in midterm examinations (3 months), it was more effective than corticosteroid.

Methods of hamstring muscle injection of botulinum toxin type A combined with periarticular injection after total knee arthroplasty

This study aimed to report on a method for injecting botulinum toxin type A into the hamstring muscles combined with periarticular injection in total knee arthroplasty (TKA) patients. We enrolled patients who underwent elective unilateral TKA at our hospital from February 2021 to December 2021 and administered botulinum toxin type A hamstring muscle injection combined with periarticular injection. We established and reported a detailed method for this combined approach, which could provide an alternative analgesic regimen after TKA in clinical practice.

Effect of Adding Perineural Methylprednisolone to Peripheral Nerve Blocks Combined With Intravenous Dexamethasone for Prolonged Postdischarge Analgesia After Fast-track Total Knee Arthroplasty

Patients undergoing total knee arthroplasty (TKA) may experience moderate-to-severe subacute pain after hospital discharge that may be undermanaged. We aimed to evaluate the effect of methylprednisolone added to ultrasound-guided peripheral nerve blocks (PNBs) combined with multimodal analgesia including intravenous dexamethasone for prolonged analgesia after early discharge. We randomized 80 patients who underwent fast-track TKA into 2 groups. All patients received a periarticular injection, PNBs, and multiple doses of intravenous dexamethasone. The methylprednisolone group received 140mg methylprednisolone in PNBs, while the nonmethylprednisolone group did not. The primary outcome was the incidence of moderate-to-severe pain (Numerical Rating Scale ≥4) during the first 12 postdischarge days. The secondary outcomes included pain scores until 3 postoperative months, incidence of rebound pain, functional performances, patient satisfaction, and adverse events. No significant between-group differences were noted in the incidence of moderate-to-severe pain during the first 12 postdischarge days (nonmethylprednisolone vs. methylprednisolone groups: 70% vs. 69.2%, P=0.941). However, this incidence was significantly higher in the methylprednisolone group between 2 weeks and 1 month (P=0.015) and between 1 and 3 months (P=0.004) postoperatively. No between-group differences in the Numerical Rating Scale scores at the postdischarge time points, incidence of rebound pain, and functional performance results were noted. Adding perineural methylprednisolone to ultrasound-guided PNBs for multimodal analgesia with intravenous dexamethasone did not prolong analgesia and improved the functional ability after fast-track TKA within 12 postdischarge days. However, the incidence moderate-to-severe pain may increase between the 2-week and 3-month follow-up.

Efficacy of Periarticular Local Infiltrative Analgesic Injection on Postoperative Pain Control and Functional Outcome in Sequential Bilateral Total Knee Replacement: A Prospective Controlled Trial in 120 Consecutive Patients.

One of the drawbacks of total knee replacements (TKR) is the early postoperative pain, which affects patient satisfaction and increases the duration of rehabilitation. The present study analyzes the potency of local infiltrative analgesia and its effect on rehabilitation in bilateral sequential TKRs. The present prospective observational study was conducted on 120 patients undergoing bilateral sequential TKR performed by a single surgeon using an anterior midline incision with a standard medial parapatellar approach. At the end of the surgery, a periarticular cocktail injection was administered to one knee, whereas the other knee served as the control. Postoperatively, patients were assessed for the pain level in each knee based on the visual analog scale (VAS) score and improvement in the range of motion (ROM). Intergroup and intragroup analyses were performed using the unpaired t test and analysis of variance, respectively. A p value of < 0.05 was considered significant. Of the 120 patients, 58% were women and 42% were men with a mean age of 62.14 ± 8.58years. The postoperative mean VAS score was significantly lower in the test knee group than in the control knee group (p < 0.05). The postoperative mean ROM was more in the test group as compared to the control group on days 3 and 7 (p < 0.05), whereas it was comparable on day 14 (p > 0.05). Periarticular injection of a drug combination in patients managed with bilateral TKRs that are done simultaneously reduces the early postoperative pain and improves rehabilitation during the first week after surgery.

Systemic Effects of Perineural Glucocorticoids on Fasting Serum Glucose, Potassium, and White Blood Cell Count in Total Hip Arthroplasty.

Glucocorticoids are commonly used as regional anesthesia adjuvants to improve blockade quality and duration. There are limited data in the literature regarding the potential systemic effects and safety of perineural glucocorticoids. This study examines the effects of perineural glucocorticoids on serum glucose, potassium, and white blood cell count (WBC) in the immediate postoperative period after primary total hip arthroplasty (THA). A retrospective cohort study was carried out at a tertiary academic medical center utilizing electronic health records of 210 patients who underwent THA, for which patients received either a periarticular local anesthetic injection alone (PAI, N=132) or additional peripheral nerve blocks (PNB, N=78) containing 10 mg dexamethasone and 80 mg methylprednisolone acetate (PAI+PNB). The primary outcome was change in serum glucose from a preoperative baseline on postoperative days (POD) 1, 2, and 3. Secondary outcomes included changes in WBC and serum potassium. The change in serum glucose from baseline was found to be significantly higher in the PAI+PNB group compared to the PAI group on POD 1 (mean difference 19.87 mg/dL, 95% CI [12.42, 27.32]; P<0.001) and POD 2 (mean difference 17.5 mg/dL, 95% CI [9.66, 25.44], P<0.001). No significant difference was found on POD 3 (mean difference -8.18 mg/dL, 95% CI [-19.07, 2.70], P=0.14). Statistically significant but clinically insignificant differences were detected in serum potassium in the PAI+PNB group compared to the PAI group on POD1 (mean difference 0.16 mEq/L, 95% CI [0.02, 0.30], P=0.03) and WBC on POD 2 (mean difference 3.18 × 1000/mm3, 95% CI [2.14, 4.22], P<0.001). Patients who underwent THA and received PAI+PNB with glucocorticoid adjuvants demonstrated higher elevations in serum glucose for the first two PODs compared to patients who received PAI alone. These differences resolved by a third POD and are likely to be of no clinical significance.

Effects of a Continuous Adductor Canal Block After Total Knee Arthroplasty.

This retrospective cohort study analyzed the short-term outcomes of patients undergoing total knee arthroplasty receiving periarticular anesthetic injections (PAIs) with and without continuous adductor canal blocks (CACBs) regarding early postoperative narcotic use, pain scores, and range of motion with otherwise similar postoperative regimens. Two hundred ninety-four patients were included: 120 received PAIs with CACBs, and 174 received PAIs only. Matched analysis was performed for type of anesthesia. There were substantial decreases in early inpatient narcotic use with the addition of CACBs to PAIs with general and spinal anesthesia without an adverse effect on pain, knee range of motion, or length of stay. [Orthopedics. 2023;46(3):185-191.].

Botulinum Toxin Versus Dextrose Prolotherapy: Which is More Effective for Temporomandibular Joint Subluxation? A Randomized Clinical Trial

Botulinum toxin type A (BTX-A) therapy or dextrose prolotherapy (DP) has been used to treat temporomandibular joint (TMJ) disorders. However, the superiority of one method over the other has not been studied in patients with TMJ subluxation. Therefore, this study aims to answer the following clinical question: among patients with TMJ subluxation, do those undergoing BTX-A injection into lateral pterygoid muscles, compared to those undergoing intra- and periarticular DP injections, have better outcomes in terms of locking episodes and patient satisfaction? A randomized clinical trial was implemented in adult patients with TMJ subluxation. The sample was composed of patients with TMJ subluxation with painful open-locking during wide mouth opening and/or yawning at baseline. The subjects were treated randomly with one of two treatment techniques with equal numbers as follows: one-session BTX-A injection into lateral pterygoid muscles (BTX-A group) or three sessions of dextrose injections around TMJ (prolotherapy group). The predictor variable was the treatment technique (BTX-A or prolotherapy injections). The primary outcome variable was the frequency of locking episodes. The secondary outcome variable was patient satisfaction. The primary outcome variable was recorded at baseline and 8-12months following the injections. The secondary outcome variable was recorded only 8-12months following the injections. Descriptive and bivariate statistics were computed. The data were analyzed with the Wilcoxon and Mann-Whitney U tests. The baseline sample was composed of 30 patients with TMJ subluxation. However, the follow-up sample comprised 25 subjects: 11 (9 females, 2 males; 25.64years) in the BTX-A group and 14 (10 females, 4 males; 32.37years) in the prolotherapy group. Locking episodes decreased significantly in the two groups with no significant difference (P<.01). Seven patients in the BTX-A group (7 of 11 patients; 63.6 percent) and eight (8 of 14 patients; 57.1 percent) in the prolotherapy group reported no complaint of locking at the end of follow-up, with no significant difference between the groups (P>.05). Patient satisfaction showed no significant difference between the groups (P>.05). These findings suggested that BTX-A injection is no more effective than DP for any outcome variables of TMJ subluxation assessed.

Efficacy of Corticosteroid Addition to a Periarticular Cocktail Injection to Counteract Nausea and Vomiting After Total Knee Arthroplasty.

Intraoperative periarticular injection of a "cocktail" of drugs is undertaken commonly in total knee arthroplasty (TKA). The addition of a corticosteroid to the periarticular injection is believed to offer greater pain relief because of its local anti-inflammatory effects, but the prevalence of postoperative nausea and vomiting (PONV) is not known. This retrospective observational study aimed to elucidate the relationship between corticosteroid addition to a periarticular cocktail injection (PCI) and PONV. Fifty-nine patients who underwent unilateral TKA for primary osteoarthritis were divided into two groups: corticosteroid and non-corticosteroid. The former had triamcinolone acetonide (40 mg) added to the same PCI. The primary outcome was the prevalence of nausea and vomiting within 48 hours following TKA. There was no significant difference between the two groups in terms of patient demographics. The overall prevalence of PONV was 16.9%. Fewer patients in the corticosteroid group complained of PONV than in the non-corticosteroid group (6.4% vs. 58.3%; p = 0.012). The addition of a corticosteroid to a PCI suppressed PONV. Our results suggested that cocktail injections may have local and systemic effects.

Quality indicators in primary elective total hip and knee arthroplasty.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) represent a significant portion of healthcare spending and are high-priority for quality improvement initiatives. This study aims to develop quality indicators (QIs) in the care of primary elective THA and TKA patients. These QIs serve a number of purposes including documentation of the quality of care, objective comparisons of institutions/providers, facilitating pay-for-performance initiatives, and supporting accountability, regulation, and accreditation. A guideline-based approach, initially described by Kötter et al., was utilized. Eight clinical practice guidelines (CPGs) were evaluated for candidate indicators (CIs). CIs with high-quality evidence and consensus statements were extracted. Eighteen additional CIs were included from previous work that evaluated quality improvement databases. Each CI and supporting evidence was submitted for independent review by an expert panel. The RAND Corporation-University of California, Los Angeles (RAND/UCLA) appropriateness methodology was utilized and items were rated based on validity, reliability, and feasibility of measurement. After two rounds of ratings and ranking, a final ranked list of QIs was obtained. Fifty-six CIs were identified from the literature and CPGs or proposed by the expert panel. Two rounds of voting resulted in 12 total QIs that were deemed appropriate measures of high-quality care. The final 12 QIs were ranked by order of importance: use of peri-operative tranexamic acid, infusion of prophylactic antibiotics prior to inflation of tourniquet, appropriate post-operative venous thromboembolic prophylaxis, complication rate, rate of secondary procedure, readmission rate, early mobilization, average change of pre- to oneyear post-operative functional status, use of multimodal analgesia, use of neuraxial anesthesia, use of peri-articular injection in TKA, and use of pre-operative PO analgesia. This study is an expert opinion based on parameters observed in modern and high-quality academic settings. Twelve QIs are proposed to assess the quality of care in the peri-operative management of primary elective THA and TKA patients.

Comparison of adductor canal block, peri–articular injection or infiltration between popliteal artery and posterior knee capsule with adductor canal block in total knee arthroplasty

Background: Moderate to severe postoperative pain is experienced by patients after total knee arthroplasty (TKA), which has an impact on postoperative rehabilitation, patient satisfaction, and overall results. Aim: Patients receiving total knee arthroplasty under general anesthesia were evaluated to see how well the combined adductor canal block and infiltration of the interspace between popliteal artery and the capsule of posterior knee block (IPACK) reduced post-operative discomfort. These treatments were compared to adductor canal block (ACB) and peri-articular injections alone (PAIs). Patients and methods: 60 patients were randomly allocated into three groups (20 in each). All that Group I patients got was an adductor block. Patients in Group II only received the periarticular injection. The IPACK (interspace between popliteal artery and posterior knee capsule) block and adductor block procedures were performed on patients in Group III. The Numeric Rating Scale (NRS) was used to measure post-operative pain as the primary endpoint both during physical therapy and when the patient was at rest. Mobilization was assisted by the Timed Up-and-Go (TUG) and MRC tests, and the second objective was postoperative analgesia, which was assessed by the total number of analgesics used and the time it took until the first rescue analgesic was delivered. Results: The total amount of morphine consumed in IQR amongst the three study groups was statistically different (p-value 0.005). Total postoperative morphine consumption in groups II and III was statistically significantly lower than in groups I (p-value 0.005), and there was also a significant difference between groups II and III (p-value 0.005), indicating that group II had significantly less total morphine consumption than the other two groups. Conclusion: In contrast to combination IPACK-ACB and ACB alone, we came to the conclusion that adding PAIs to the pain management regimen for patients having TKA enhances analgesia quality and reduces opioid intake. Even though the combined IPACK-ACB block was less successful than PAIs, it nevertheless showed superior pain scores at rest and during physiotherapy and required less opioid consumption than ACB alone, making it a viable option to PAIs in situations where this technique is not practical.

A Randomized Double-Blind Prospective Study Comparing the Efficacy of Subperiosteal and Periarticular Injections of a Local Anesthetic for Postoperative Pain Management after Total Knee Arthroplasty.

Total knee arthroplasty (TKA) serves as an effective surgical treatment method for advanced osteoarthritis (OA). Nonetheless, it is associated with postoperative pain that can influence patients' functional outcome. This study aimed to compare the analgesic effect of subperiosteal and periarticular injection methods of a special local anesthetic in patients who underwent TKA. This double-blind prospective clinical study was conducted on patients with advanced knee OA who underwent TKA. Patients were randomly divided into two groups, with a local anesthetic (21 ml) administered either in periarticular (P group) or subperiosteal (S group) forms prior to wound closure. The local anesthetic consisted of lidocaine 2% (15 cc), dexmedetomidine (1 cc), and marcaine 0.5% (5 cc). A study-blinded orthopedic resident recorded postoperative pain levels using a 10-point visual analogue score (VAS) (0 indicating no pain, 10 indicating worst pain) at 6, 12, 24, and 48 hours after surgery. A total of 40 patients (P and S group; n=20 each), consisting of 10 males (mean age=67.4 years old), were included in this study. The intensity of pain in the S group was significantly lower than in the P group 24 hours after surgery (mean VAS scores in the P group: 4±1 vs. the S group: 3.3±0.7, P=0.024). Furthermore, VAS scores at 6, 12, and 48 hours post-surgery were lower in the S group compared to the P group; however, the difference was not statistically significant (P>0.05). Our study indicated that subperiosteal injection of lidocaine, dexmedetomidine, and marcaine is more effective than periarticular injection, providing effective postoperative pain management after TKA.