medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2022, Number 1

<< Back Next >>

Acta Ortop Mex 2022; 36 (1)

Pain control with local infiltration transsurgical in postoperative total knee replacement

Treviño-Ordóñez K, Meza-Flores J, Valverde-Galindo L

Language: Spanish
References: 28
Page: 8-13
PDF size: 198.17 Kb.


ABSTRACT

Introduction: 15-20% of patients undergoing total knee arthroplasty were not satisfied and the most common causes were residual pain and limited function. Epidural analgesia or peripheral nerve blocks have traditionally been used as analgesia. Objective: To evaluate the efficacy of infiltration with epinephrine, ketorolac, morphine and ropivacaine solution in postoperative total knee replacement patients. Material and methods: Observational, cross-sectional, retrospective and analytical cohort study. We included patients with gonarthrosis aged 18 to 100 years scheduled for total knee replacement surgery from May 2018 to August 2021; with documentation of their clinical, demographic, baseline, pre-surgical and postoperative pain data at 24 hours. Infiltrated patients were compared with those receiving intravenous analgesia. Results: A total of 66 patients with a mean age of 69.1 were included;65.2% were women. Forty-three point nine percent had left-sided involvement, 50% had a classification of Kellgren-Lawrence III and 31.8% had a grade IV. Thirty-six patients (54.5%) formed the control group, while 30 (45.5%)received the intervention with the analgesic cocktail. With regard to pain,a lower median pain was found by visual analog scale in patients with the intervention (2 vs 8 points, p < 0.001); most with the cocktail they found no pain (66.7%) or mild pain (23.3%) and no patient in the control group reached it (p < 0.001). All patients of the control group required rescue analgesia, while only 30% of the intervention group used it (p < 0.001). Conclusion: The use of trans-surgical local infiltration decreases postoperative pain and the requirement of analgesics and rescue analgesia during the first 24 hours.


REFERENCES

  1. Andersen KV, Nikolajsen L, Haraldsted V, Odgaard A, Soballe K. Local infiltration analgesia for total knee arthroplasty: should ketorolac be added? BJA: British Journal of Anaesthesia. 2013; 111(2): 242-8. doi: 10.1093/bja/aet030.

  2. Cole BJ, Harner CD. Degenerative arthritis of the knee in active patients: evaluation and management. J Am Acad Orthop Surg. 1999; 7(6): 389-402. doi: 10.5435/00124635-199911000-00005.

  3. Danoff JR, Goel R, Henderson RA, Fraser J, Sharkey PF. Periarticular ropivacaine cocktail is equivalent to liposomal bupivacaine cocktail in bilateral total knee arthroplasty. J Arthroplasty. 2018; 33(8): 2455-9. doi: 10.1016/j.arth.2018.02.083.

  4. Fan L, Zhu C, Zan P, Yu X, Liu J, Sun Q, et al. The comparison of local infiltration analgesia with peripheral nerve block following total knee arthroplasty (TKA): a systematic review with meta-analysis. J Arthroplasty. 2015; 30(9): 1664-71. doi: 10.1016/j.arth.2015.04.006.

  5. Gi E, Yamauchi M, Yamakage M, Kikuchi C, Shimizu H, Okada Y, et al. Effects of local infiltration analgesia for posterior knee pain after total knee arthroplasty: comparison with sciatic nerve block. J Anesth. 2014; 28(5): 696-701.

  6. Gibbs DM, Green TP, Esler CN. The local infiltration of analgesia following total knee replacement: a review of current literature. J Bone Joint Surg Br. 2012; 94(9): 1154-9.

  7. Keijsers R, Delft RV, Michel PJ, Van Den Bekerom Dirk CAA, De Vries, Brohet RM, et al. Local infiltration analgesia following total knee arthroplasty: effect on post-operative pain and opioid consumption-a meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2013; 23(7): 1956-1963. doi: 10.1007/s00167-013-2788-1.

  8. Klug MJ, Rivey MP, Carter JT. Comparison of intraoperative periarticular injections versus liposomal bupivacaine as part of a multimodal approach to pain management in total knee arthroplasty. Hosp Pharm. 2016; 51(4): 305-11. doi: 10.1310/hpj5104-305.

  9. Lee YS. Comprehensive analysis of pain management after total knee arthroplasty. Knee Surg Relat Res. 2017; 29(2): 80-6. doi: 10.5792/ksrr.16.024.

  10. Mahadevan D, Walter RP, Minto G, Gale TC, McAllen CJ, Oldman M. Combined femoral and sciatic nerve block vs combined femoral and periarticular infiltration in total knee arthroplasty: a randomized controlled trial. J Arthroplasty. 2012; 27(10): 1806-11.

  11. Meftah M, Wong AC, Nawabi DH, Yun RJ, Ranawat AS, Ranawat CS. Pain management after total knee arthroplasty using a multimodal approach. Orthopedics. 2012; 35(5): e660-4.

  12. Ranawat AS, Ranawat CS. Pain management and accelerated rehabilitation for total hip and total knee arthroplasty. J Arthroplasty. 2007; 22(7 Suppl 3): 12-5. doi: 10.1016/j.arth.2007.05.040.

  13. Xu CP, Li X, Wang ZZ, Song JQ, Yu B. Efficacy and safety of single-dose local infiltration of analgesia in total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee. 2014; 21(3): 636-46.

  14. Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. 1998; 87(1): 88-92.

  15. Ganapathy S, Wasserman RA, Watson JT, Bennett J, Armstrong KP, Stockall CA, et al. Modified continuous femoral three-in-one block for postoperative pain after total knee arthroplasty. Anesth Analg. 1999; 89 (5): 1197-202.

  16. Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R, et al. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty. 2001; 16 (4): 436-45.

  17. Afzal A, Hawkins F, Rosenquist R W. Epidural hematoma in a patient receiving epidural analgesia and LMWH after total-knee arthroplasty. Reg Anesth Pain Med. 2006; 31 (5): 480.

  18. Dahl JB, Møiniche S, Kehlet H. Wound infiltration with local anaesthetics for postoperative pain relief. Acta Anaesthesiol Scand. 1994: 38(1): 7-14.

  19. DeWeese F T, Akbari Z, Carline E. Pain control after knee arthroplasty: Intraarticular versus epidural anesthesia. Clin Orthop. 2001; (392): 226-31.

  20. Reilly KA, Beard DJ, Barker KL, Dodd CAF, Price AJ, Murray DW. Efficacy of an accelerated recovery protocol for Oxford unicompartmental knee arthroplasty-a randomised controlled trial. Knee. 2005; 12(5): 351-7.

  21. Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin M, Varin F. A multimodal analgesia protocol for total knee arthroplasty. J Bone Joint Surg. 2006; 88(2): 282-9.

  22. Bianconi M, Ferraro L, Traina G C, Zanoli G, Antonelli T, Guberti A, et al. Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery. Br J Anaesth. 2003; 91: 830-5.

  23. Fischer HBJ, Simanski CJP. Review article, A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia. 2005; 60(12): 1189-202.

  24. Strassels SA, Chen C, Carr DB. Postoperative analgesia: economics, resource use, and patient satisfaction in an urban teaching hospital. Anesth Analg. 2002; 94(1): 130-7.

  25. Romsing J, Møiniche S, Ostergaard D, Dahl J B. Local infiltration with NSAIDs for postoperative analgesia: evidence for a peripheral analgesic action. Acta Anaesthesiol Scand. 2000; 44(6): 672-83.

  26. Forslund C, Bylander B, Aspenberg P. Indomethacin and celecoxib improve tendon healing in rats. Acta Orthop Scand. 2003; 74(4): 465-9.

  27. Dahners LE, Mullis BH. Effects of nonsteroidal anti-inflammatory drugs on bone formation and soft-tissue healing. J Am Acad Orthop Surg. 2004; 12: 139-43.

  28. Aspenberg P. Avoid cox inhibitors after skeletal surgery! (Guest editorial). Acta Orthop Scand. 2002; 73(5): 489-90.



EVIDENCE LEVEL

III




2020     |     www.medigraphic.com