Analgesic Effect among Three Drug Regimens for Local Infiltration Analgesia after Total Knee Arthroplasty

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Aumjit Wittayapairoj Kriangkrai Wittayapairoj Paphatsara Phuangpraphan Malinee Wongswadiwat Yuwadee Huntula


Background and Objectives: Total knee arthroplasty (TKA) is a major procedure which causes severe pain. Adequate pain management promotes rehabilitation and shortens hospital stay. There are several methods for controlling pain after TKA. One of the techniques is local infiltration analgesia (LIA), which is done by injecting the combination of drugs into periarticular tissue. However, variety of drugs can be used for LIA. We aimed to evaluate the postoperative analgesic effect of three different regimens of LIA in TKA patients.

Methods:  Retrospective study was conducted in patients who underwent TKA between January 1, 2015 and December 31, 2017 and received one of three different regimens of LIA (group 1; bupivacaine 200 mg plus ketorolac 30 mg and morphine 8 mg, group 2; bupivacaine 200 mg plus ketorolac 60 mg and adrenaline 0.03 mg and group 3; bupivacaine 200 mg plus ketorolac 60 mg, morphine 8 mg and triamcinolone 40 mg) Postoperative morphine consumption, numeric rating pain scores (NRS) at 24 and 48 h and additional analgesic drugs were recorded for assessing pain efficacy. Adverse events were also recorded.

Results: Sixty patients were enrolled, of which 18, 29 and 13 patients received gr.1, 2 and 3 regimen, respectively. Patients’ characteristics were comparable. Postoperative morphine consumption at 24 and 48 h were not different [16.9(12.1), 13.1(8.7) and 12.4(11.1), p = 0.39 and 28.2(15.9), 24.5(14.2) and 22.7(15.6), p = 0.57). Postoperative NRS at rest and on movement were similar at 24 h [3.3(3.1), 2.4(2.5) and 2.3(2.5), p=0.44 and 5.5(3.2), 4.1(3.1) and 4.4(2.1), p=0.28] and at 48 h [2.5(2.5), 2.4(2.2) and 1.8(2.0), p=0.62 and 5.2(1.9), 4.5(2.3) and 4.2(2.1), p=0.39]. All adverse events were similar and no serious complications occurred.

Conclusions: The all three drug regimens of LIA for TKA can relieved postoperative pain to mild pain. The analgesic effect and adverse events were not different among groups.


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