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Pre-emptive injection of peri-articular-multimodal drug for post-operative pain management in total knee arthroplasty: a double-blind randomized clinical trial

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Abstract

Purpose

Severe post-operative pain is one of the main problems after total knee arthroplasty. In this study, we investigated the effect of a peri-articular multimodal drugs injections pre-emptively on post-operative pain control and knee functions following total knee arthroplasty.

Methods and materials

This study was a double-blind randomized clinical trial. Eligible cases including 137 patients—aged 30 to 80 years old—were randomly divided into one of two groups: the drug group received a cocktail consisting of bupivacaine hydrochloride, morphine sulphate, epinephrine, and ketorolac. The control group received epinephrine only. The injections were given 15 minutes before incision. Joint range of motion (ROM) and the severity of pain by using visual analog scale (VAS) of 1 to 10 and patient’s facial expression, were assessed in the pre-operative visit, after 24 hours, 48 hours, and six weeks after operation. Knee Society score (KSS) was recorded before the operation, six weeks, and six months after the operation for each patient.

Results

The data of VAS showed no significant difference between the groups before operation but there was statistically significant difference between the two groups at 24 hours, 48 hours, and six weeks after the operation. In KSS, difference was not significant between the two groups before the operation and six months after surgery while our results showed a statistically significant difference between groups six weeks after the operation. In ROM, there was no significant difference between the groups before operation. There was a statistically significant difference between the two groups at 24 hours, 48 hours and six weeks after the operation. Complications were recorded at six weeks after surgery.

Conclusion

Peri-articular multimodal injection including bupivacaine, morphine, and ketorolac preferably with pre-emptive injection method provided proper post-operative pain relief, less opioid consumption, and better early rehabilitation following TKA at 48 hours after surgery.

Level of study

Level I.

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Acknowledgements

The authors wish to express their thanks to all hospital personnel involved in this study for their cooperation. We also express our especial thanks to Prof. Azim Honarmand, a faculty member at the Department of Anesthesiology affiliated with the Isfahan University of Medical Sciences for their cooperation with us in the scientific revision.

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Authors and Affiliations

  1. Department of Orthopaedics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

    Mahdi Motififard, Ali Omidian & Sajad Badiei

  2. Students Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Sajad Badiei

Authors
  1. Mahdi Motififard
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  2. Ali Omidian
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  3. Sajad Badiei
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Corresponding author

Correspondence to Ali Omidian.

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Conflict of interest

The authors of this study have no conflict of interests.

Funding source

This work was supported by the Medical Research Council at Isfahan University of Medical Sciences.

Ethical approval

The protocol of this study was approved by the Ethics Committee and the review board of the Isfahan University of Medical Sciences (Project No. 394048, Clinical Trial Registration No. IRCT2016073129132N2). This study was performed only on humans. This article does not contain any previous phases on human participants or animals performed by any of the authors. The manuscript has not been submitted to other journals. The manuscript has not been published previously (partly or in full). No data have been fabricated or manipulated (including images) to support our conclusions. We have not used any data, text or theories presented by others in this study at all. In the section of discussion, all subjects presented by others are mentioned with their references. So there is no plagiarism.

Informed consent

Informed consent was obtained from all individual participants included at the beginning of the study.

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Motififard, M., Omidian, A. & Badiei, S. Pre-emptive injection of peri-articular-multimodal drug for post-operative pain management in total knee arthroplasty: a double-blind randomized clinical trial. International Orthopaedics (SICOT) 41, 939–947 (2017). https://doi.org/10.1007/s00264-016-3357-2

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  • DOI: https://doi.org/10.1007/s00264-016-3357-2

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