47. EFFICACY OF CONTINUOUS PERIARTICULAR COCKTAIL INFUSION FOR PAIN CONTROL AFTER TOTAL KNEE REPLACEMENT
Main Article Content
Abstract
Objective: This study aimed to evaluate the benefits of continuous periarticular cocktail infusion in total knee replacement patients in terms of pain control and early restoration of knee range of motion after surgery.
Methods: A total of 50 patients undergoing unilateral total knee replacement were enrolled and divided into two groups: one group received continuous cocktail infusion into the joint capsule, while the other group received continuous Ropivacaine infusion into the adductor canal. During surgery, all patients were given periarticular injections consisting of Ropivacaine, Ketorolac, Dexamethason, and Epinephrine. Perioperative analgesia protocols were standardized for all patients. Pain scores VAS and knee range of motion were recorded on the day of surgery, postoperative day 1, postoperative day 2, and at discharge. Complications and the need for rescue analgesics were also monitored.
Results: Patients in the continuous periarticular cocktail group had a mean VAS score of 0.8 ± 1.5 and showed better functional recovery, with the ability to flex the knee to 90 degrees within 2 days. The requirement for rescue analgesics was significantly reduced at 6 hours, 12 hours, and within the first 24 hours postoperatively. No cases of local anesthetic toxicity or other complications were observed.
Conclusion: Continuous periarticular cocktail infusion following intraoperative cocktail injection significantly reduces postoperative analgesic requirements and improves patient satisfaction without increasing complication risks after total knee replacement.
Article Details
Keywords
Total knee replacement, multimodal analgesic cocktail, knee range of motion
References
[2] Atar S, Demirhan E, Cabuk H, Turan K, Dedeoglu S.S, Kuru Ö. Comparison of pain, muscle strength, and functional status following unicompartmental knee arthroplasty, total knee arthroplasty, and conservative management of gonarthrosis. Indian Journal of Orthopaedics, 2022, 56 (3, article 549): 464-472. doi: 10.1007/s43465-021-00549-5. [DOI] [PMC free article] [PubMed] [Google Scholar].
[3] Horlocker T.T, Hebl J.R, Kinney M.A et al. Opioid-free analgesia following total knee arthroplasty: A multimodal approach using continuous lumbar plexus (psoas compartment) block, acetaminophen, and Ketorolac. Regional Anesthesia and Pain Medicine, 2002, 27, 105-108.
[4] Busch C.A, Shore B.J, Bhandari R et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. Journal of Bone and Joint Surgery, 2006 May, 88 (5): 959-963.
[5] Spreng U.J, Dahl V, Hjall A, Fagerland M.W, Raeder J. High volume local infiltration analgesia combined with intravenous or local Ketorolac + Morphine compared with epidural analgesia after total knee arthroplasty. British Journal of Anaesthesia, 2010, 105 (5), 675-682.
[6] Sreedharan Nair V, Ganeshan Radhamony N, Rajendra R, Mishra R. Effectiveness of intraoperative periarticular cocktail injection for pain control and knee motion recovery after total knee replacement. Arthroplasty Today, 2019, 5 (3): 320-4. doi:10.1016/j.artd.2019.05.004
[7] Solanki D.R, Enneking F.K, Ivey F.M, Scarborough M, Johnston R.V. Serum bupivacaine concentrations after intraarticular injection for pain relief after knee arthroscopy. Arthroscopy. 1992; 8: 44-7
[8] Christensen C.P, Jacobs C.A, Jennings H.R. Effect of periarticular corticosteroid injections during total knee arthroplasty. A double-blind randomized trial. J Bone Joint Surg [Am], 2009, 91-A, 2550-2555.
[9] Avinash Bajjuri, Deepak Kaki, Karan Shetty, Venugopal S.M, Sivaprakash P, Jishnu J. Periarticular cocktail injection for analgesia and post-operative knee motion following total knee arthroplasty - a study on efficacy and safety. Int J Acad Med Pharm, 2024, 6 (1), 6-9.
[10] Ulrik Grevstad, Ole Mathiesen, Laura Staun Valentiner, Pia Jaeger, Karen Lisa Hilsted, Jørgen B Dahl. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, blinded study. Reg Anesth Pain Med, 2015, 40 (1): 3-10.
[11] Julián Aliste et al. Randomized comparison between pericapsular nerve group (PENG) block and suprainguinal fascia iliaca block for total hip arthroplasty. Reg Anesth Pain Med, 2021, 46, pp. 874-878.