Which analgesic mixture is appropriate for periarticular injection after total knee arthroplasty? Prospective, randomized, double-blind study

被引:47
作者
Kim, Tae Woo [1 ]
Park, Sang Jae [2 ]
Lim, Se Hyeok [2 ]
Seong, Sang Cheol [2 ]
Lee, Sahnghoon [2 ]
Lee, Myung Chul [2 ]
机构
[1] Hallym Univ Hosp, Dept Orthopaed Surg, Chuncheon Si 200704, Gangwon Do, South Korea
[2] Seoul Natl Univ Hosp, Dept Orthopaed Surg, Seoul 110744, South Korea
关键词
Periarticular injection; Total knee arthroplasty; Drug combination; Analgesics; MULTIMODAL DRUG INJECTION; ARTICULAR STEROID INJECTION; PAIN MANAGEMENT; POSTOPERATIVE PAIN; LOCAL INFILTRATION; EPIDURAL ANALGESIA; REPLACEMENT; EFFICACY; HIP; REHABILITATION;
D O I
10.1007/s00167-014-3366-x
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Although the analgesic effect of periarticular injection after total knee arthroplasty (TKA) has been well documented, the gold standard for drug combination has not yet been established. In this study, the analgesic effects of six different drug combinations were compared. A total of 256 patients undergoing TKA for primary osteoarthritis were randomized into one of six groups: a control group (saline solution, epinephrine, and cefazolin, n = 42), Group 1 (ropivacaine, n = 43), Group 2 (ropivacaine + morphine, n = 43), Group 3 (ropivacaine + ketorolac, n = 42), Group 4 (ropivacaine + morphine + ketorolac, n = 43), and Group 5 (ropivacaine + morphine + ketorolac + methylprednisolone, n = 43). Pain level assessed by visual analogue scale (VAS) and opioid consumption were primary outcomes. The incidence of complications, range of motion (ROM), C-reactive protein (CRP) value, and the amount of post-operative blood drainage were also compared. Patients in Groups 4 and 5 complained less pain than the control group for the first 12 h after surgery, and the patients in the other groups showed less pain only during the initial 6 h after surgery. Groups 4 and 5 also showed less opioid consumption than the control group during the 24 h period after surgery. Patients in Group 5 showed no significant difference in VAS score and opioid consumption compared with Group 4, but they had lower CRP value and greater ROM than any other groups at post-operative day 2 and day 4. The combination of ropivacaine, morphine, and ketorolac showed a significantly stronger and sufficiently synergistic analgesic effect without adding methylprednisolone in periarticular injection after TKA. The clinical relevance of the study is that the combination of ropivacaine, morphine, and ketorolac can be a good option for periarticular injection following TKA in terms of synergistic analgesic effect and efficiency of drug combination.
引用
收藏
页码:838 / 845
页数:8
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