Multimodal Post-Operative Pain Management Using Intraoperative Periarticular Cocktail Injection In Total Knee Arthroplasties
European Journal of Molecular & Clinical Medicine,
2021, Volume 8, Issue 4, Pages 2994-3005
Abstract
INTRODUCTION: Total knee arthroplasty (TKA) is one of the best methods for end stage osteoarthritis of knee joint that relieves pain and improves joint function. Most important problem which the patient suffers is postoperative pain, which has harmful effects on patient’s rehabilitation. The aim of our study was to assess the postoperative pain relief and functional outcome following use of combination of drugs which we used as intraoperative, periarticular cocktail injection.MATERIALS AND METHODS: It is a prospective interventional study consisting of 40 TKA’s done in a single unit. All patients underwent TKA under spinal anaesthesia and underwent standard postoperative protocol. Intraoperative periarticular cocktail consisting of Bupivacaine 0.5% (20ml), Adrenaline 0.3 ml (1:1000), ketorolac 30mg/1ml, methylprednisolone 40mg//1ml, cefuroxime 750mg/10ml with 27.7 ml of normal saline to make total of 60ml solution was given. Assessment of pain was done by visual analogue scale (VAS) and functional assessment by knee society score postoperatively. The number of rescue analgesia used was recorded.
RESULTS: Mean age of patients was 64 years (47-76) with females predominantly affected than males. Mean static VAS at 6 hours was 4.3 and dynamic VAS at 1st recording was 4.9. there was a strong correlation between Body Mass Index and Dynamic VAS at 1st and Dynamic VAS at 3rd recording with p < 0.05. Patient satisfaction and functional scores improved postoperatively and there was a statistically significant improvement in knee ROM (P< 0.05). only 2 patients received more than 3 doses of rescue analgesia due to high BMI. No complications related to the infiltration of the local anaesthetic were observed.
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