Effectiveness of Periarticular Cocktail Injection in Pain Management of Patients Undergoing Total Knee Arthroplasty

Vol 43 | January 2022 | page: 10-13 | Priya Ranjan Acharya

DOI: 10.13107/ojot.2022.v43i01.026


Authors: Priya Ranjan Acharya [1]

[1] Department of Orthopaedics, SCB Medical College, Cuttack, Odisha, India.

Address of Correspondence

Dr. Priya Ranjan Acharya
Department of Orthopaedics, SCB Medical College, Cuttack, Odisha, India.
E-mail: priyaranjanacharya190394@gmail.com


Abstract

Introduction: Total knee arthroplasty is a procedure that can improve quality of life, and it is performed in increasing numbers every year because of the increase in the elderly population due to improved medical technology. However, the problem is that patients avoid this operation because of postoperative pain, which affects patient satisfaction and delays recovery and rehabilitation.
There are many modalities to improve operative pain control, such as femoral nerve blocks, epidural anaesthesia, and periarticular injections. These modalities have been shown to reduce post-operative pain and increase patient satisfaction. Periarticular injection was reported to have good efficacy in controlling pain, cost-effectiveness, a few side effects, and ease of use. This method can be used by every surgeon without further training, unlike techniques like epidural anaesthesia or femoral nerve blocks, which require experience and further training.
Material and Methods: The study was conducted in the Department of Orthopaedics at SCB Medical College & Hospital, Cuttack, Odisha. All the IPD patients who got admitted to the Dept. of Orthopaedics were taken as the study subject total of 30 cases were selected during study period out of which 15 were cases and 15 controls.
Observation and Discussion: In Group A, R/L TKA was done in 3/12 patients and in Group B, R/L TKA was done in 8/7. All the Group A patients experienced less pain than the baseline parameters(p<0.05) following TKA. Post-operative evaluation of Range of motion in between 2 Groups there was significant difference in between the two Groups A and B as it was comparatively more in POD1, POD2, POD3, POD7, DOD AND 3 months after follow up in Cocktail Group A. Knee Society Score in POD3 was found to be 100 and 90 in Group A and Group B respectively.
Conclusion: This study has several strengths. First, it is a well powered, randomized study. Second, we included follow-up beyond the initial hospitalization. Third, the injection medications we used are available through any hospital pharmacy and are easily administered during the surgical procedure, so our findings could be generalized for any joint reconstruction surgeon.
Keywords: Total knee replacement, Periarticular injection, Pain management


References

1. Maheshwari AV, Blum YC, Shekhar L, Ranawat AS, Ranawat CS: Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center: Clinical Orthopaedics and Related Research, (2009) 467:1418–1423.
2. David S, Pereira SD, de Albuquerque RA, Silva MZ, Fernandes RJC, Colavolpe PO: Local periarticular analgesia in total knee Arthroplasty: ActaOrtop Bras. 2017;25(2):81-4.
3. Kelley TC, Adams MJ, Mulliken BD, Dalury DF: Efficacy of Multimodal Perioperative Analgesia Protocol With Periarticular Medication Injection in Total Knee Arthroplasty: A Randomized, Double-Blinded Study: The Journal of Arthroplasty (2013), Page 1-4.
4. Shah V, Upadhyay S, Shah K: Multimodal cocktail injection relieves post operative pain and improves early rehabilitation following Total knee replacement: a prospective blinded and randomized study: Journal on Recent Advances in Pain, Jan-April 2017; 391):14-24.
5. Nair VS, Radhamony NG, Rajendra R, Mishra R: Effectiveness of intraoperative periarticular cocktail injection for pain control and knee motion recovery after total knee replacement: Arthroplasty Today 5 (2019) 320-324.
6. Martin NJ, Padmanabhan V, Pindis JJ: Efficacy of Periarticular Cocktail Injection in Rheumatoid Patients Undergoing Total Knee Replacement: Indian Journal of Orthopaedics: 2020 (112-124).
7. Vendittole PA, Makinen P, Drolet P; A multimodal analgesia protocol for total knee arthroplasty: a randomized control trial: Journal of Bone joint Surg Am : 2006: Feb: 88(2):282-289.
8. Koh IJ, Kang YG, Chang CB, Kwon SK, Seo ES, Seong SC, et al. Additional pain relieving effect of intraoperative periarticular injections after simultaneous bilateral TKA: a randomized, controlled study. Knee Surg Sports TraumatolArthrosc Off J ESSKA. 2010;18(7):916–22.
9. Todd CA, Mariano ER. Best multimodal analgesic protocol for total knee arthroplasty. Pain Manag. 2015;5(3):185–96.

How to Cite this Article: Acharya PR |  Effectiveness of Periarticular Cocktail Injection in Pain Management of Patients Undergoing Total Knee Arthroplasty | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 10-13.

(Abstract Text HTML)    (Download PDF)