Percutaneous periarticular analgesic injection After TKA Relieves Post-operative Pain
Pain management in the early period is one of the most important factors in total knee arthroplasty (TKA) as the intense postoperative pain in the early period after TKA affects patient satisfaction. A recent study suggests that percutaneous periarticular analgesic injection at 1 day after TKA improves postoperative pain. The study findings were published in the Journal of Orthopaedic Surgery and Research on June 01, 2021.
Intraoperative periarticular multi-drug injection has been reported to be effective in many studies as multimodal pain management after TKA. A previous study suggests that the early postoperative pain score at rest after unilateral TKA was lower in patients with the additional percutaneous periarticular multi-drug injection (additional injection). However, there is no information on the efficacy of this additional injection for simultaneous bilateral TKA. Therefore, Dr Takuya Iseki and his team conducted a study to assess the clinical effectiveness of percutaneous periarticular injection at 1 day following simultaneous bilateral TKA.
It was a prospective, single-centre, two-arm, parallel-group, open-label, and randomized controlled study of 44 patients (88 knees) who underwent simultaneous bilateral TKA. The researchers randomly as////signed the patients to receive a percutaneous periarticular injection at 1 day following surgery (n = 22 patients) or no injection (n = 22 patients). In the additional injection group, they injected a solution including methylprednisolone, ropivacaine, and epinephrine into the muscle belly of the vastus medialis at 1 day after surgery. All patients received an intraoperative periarticular multi-drug injection and postoperative intravenous and oral nonsteroidal anti-inflammatory drugs. The major outcome assessed was the postoperative pain at rest measured using a visual analogue scale (VAS) and analyzed with Student's t-test.
Key findings of the study were:
- Upon analysis, the researchers found that compared to the no additional injection group, the additional periarticular injection group had a significantly lower VAS score at
◊ 8:00 PM postoperative day 1,
◊ 6:00 AM postoperative day 2,
◊ 12:00 PM postoperative day 2,
◊ 6:00 AM postoperative day 5,
◊ 12:00 PM postoperative day 5, and
◊ 8:00 PM postoperative day 5.
- They reported a similar rate of complication in both groups.
The authors concluded, "The additional percutaneous periarticular multi-drug injection at 1 day after simultaneous bilateral TKA may reduce early postoperative pain more effectively than no additional injection. This technique may be a new method for postoperative pain control after TKA."
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