Effects of Periarticular Multimodal Drug Injection on Pain Control, Early Mobilization, and Length of Hospital Stay in Patients Undergoing Total Knee Arthroplasty
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Kurtz, S.; Ong, K.; Lau, E.; Mowat, F.; Halpern, M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J. Bone Jt. Surg. Am. 2007, 89, 780–785. [Google Scholar] [CrossRef]
- Ranawat, A.S.; Ranawat, C.S. Pain management and accelerated rehabilitation for total hip and total knee arthroplasty. J. Arthroplast. 2007, 22, 12–15. [Google Scholar] [CrossRef]
- Geng, X.; Zhou, S.; Zhang, X.; Liu, X.; Cheng, X.; Jiang, L.; Zhang, D. The Efficacy and Safety of Celecoxib for Pain Management After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front. Surg. 2022, 9, 791513. [Google Scholar] [CrossRef] [PubMed]
- 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. Arthroplast. Today 2019, 5, 320–324. [Google Scholar] [CrossRef]
- Fletcher, D.; Fermanian, C.; Mardaye, A.; Aegerter, P. A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges. Pain 2008, 137, 441–451. [Google Scholar] [CrossRef]
- Breivik, H.; Stubhaug, A. Management of acute postoperative pain: Still a long way to go! Pain 2008, 137, 233–234. [Google Scholar] [CrossRef]
- Correll, D.J.; Vlassakov, K.V.; Kissin, I. No evidence of real progress in treatment of acute pain, 1993–2012: Scientometric analysis. J. Pain Res. 2014, 7, 199–210. [Google Scholar] [CrossRef]
- Kerr, D.R.; Kohan, L. Local infiltration analgesia: A technique for the control of acute postoperative pain following knee and hip surgery: A case study of 325 patients. Acta Orthop. 2008, 79, 174–183. [Google Scholar] [CrossRef] [PubMed]
- Andersen, L.; Kehlet, H. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: A systematic review. Br. J. Anaesth. 2014, 113, 360–374. [Google Scholar] [CrossRef]
- Lavand’homme, P.M.; Kehlet, H.; Rawal, N.; Joshi, G.P. Pain management after total knee arthroplasty: PROcedure SPEcific Postoperative Pain ManagemenT recommendations. Eur. J. Anaesthesiol. 2022, 39, 743–757. [Google Scholar] [CrossRef] [PubMed]
- Xu, C.P.; Li, X.; Wang, Z.Z.; Song, J.Q.; Yu, B. Efficacy and safety of single-dose local infiltration of analgesia in total knee arthroplasty: A meta-analysis of randomized controlled trials. Knee 2014, 21, 636–646. [Google Scholar] [CrossRef] [PubMed]
- Seangleulur, A.; Vanasbodeekul, P.; Prapaitrakool, S.; Worathongchai, S.; Anothaisintawee, T.; McEvoy, M.; Vendittoli, P.A.; Attia, J.; Thakkinstian, A. The efficacy of local infiltration analgesia in the early postoperative period after total knee arthroplasty: A systematic review and meta-analysis. Eur. J. Anaesthesiol. 2016, 33, 816–831. [Google Scholar] [CrossRef] [PubMed]
- Fang, R.; Liu, Z.; Alijiang, A.; Jia, H.; Deng, Y.; Song, Y.; Meng, Q. Efficacy of Intra-articular Local Anesthetics in Total Knee Arthroplasty. Orthopedics 2015, 38, e573–e581. [Google Scholar] [CrossRef] [PubMed]
- Zhang, Z.; Shen, B. Effectiveness and weakness of local infiltration analgesia in total knee arthroplasty: A systematic review. J. Int. Med. Res. 2018, 46, 4874–4884. [Google Scholar] [CrossRef] [PubMed]
- Joo, J.H.; Park, J.W.; Kim, J.S.; Kim, Y.H. Is intra-articular multimodal drug injection effective in pain management after total knee arthroplasty? A randomized, double-blinded, prospective study. J. Arthroplast. 2011, 26, 1095–1099. [Google Scholar] [CrossRef] [PubMed]
- Lavie, L.G.; Fox, M.P.; Dasa, V. Overview of Total Knee Arthroplasty and Modern Pain Control Strategies. Curr. Pain Headache Rep. 2016, 20, 59. [Google Scholar] [CrossRef] [PubMed]
- Koh, I.J.; Kang, Y.G.; Chang, C.B.; Kwon, S.K.; Seo, E.S.; Seong, S.C.; Kim, T.K. Additional pain relieving effect of intraoperative periarticular injections after simultaneous bilateral TKA: A randomized, controlled study. Knee Surg. Sports Traumatol. Arthrosc. 2010, 18, 916–922. [Google Scholar] [CrossRef] [PubMed]
- Kim, T.W.; Park, S.J.; Lim, S.H.; Seong, S.C.; Lee, S.; Lee, M.C. Which analgesic mixture is appropriate for periarticular injection after total knee arthroplasty? Prospective, randomized, double-blind study. Knee Surg. Sports Traumatol. Arthrosc. 2015, 23, 838–845. [Google Scholar] [CrossRef]
- Liu, M.; Zhang, D.; Shi, B. Comparison of the Post-Total Knee Arthroplasty Analgesic Effect of Intraoperative Periarticular Injection of Different Analgesics. J. Coll. Physicians Surg. Pak. 2019, 29, 1169–1172. [Google Scholar] [CrossRef] [PubMed]
- Saklad, M. Grading of Patients for Surgical Procedures. Anesthesiology 1941, 2, 281–284. [Google Scholar] [CrossRef]
- Kellgren, J.H.; Lawrence, J.S. Radiological assessment of osteo-arthrosis. Ann. Rheum. Dis. 1957, 16, 494–502. [Google Scholar] [CrossRef]
- Jiang, J.; Teng, Y.; Fan, Z.; Khan, M.S.; Cui, Z.; Xia, Y. The efficacy of periarticular multimodal drug injection for postoperative pain management in total knee or hip arthroplasty. J. Arthroplast. 2013, 28, 1882–1887. [Google Scholar] [CrossRef]
- Busch, C.A.; Shore, B.J.; Bhandari, R.; Ganapathy, S.; MacDonald, S.J.; Bourne, R.B.; Rorabeck, C.H.; McCalden, R.W. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J. Bone Jt. Surg. Am. 2006, 88, 959–963. [Google Scholar] [CrossRef] [PubMed]
- Tammachote, N.; Kanitnate, S.; Manuwong, S.; Panichkul, P. Periarticular multimodal drug injection is better than single anesthetic drug in controlling pain after total knee arthroplasty. Eur. J. Orthop. Surg. Traumatol. 2018, 28, 667–675. [Google Scholar] [CrossRef] [PubMed]
- Mullaji, A.; Kanna, R.; Shetty, G.M.; Chavda, V.; Singh, D.P. Efficacy of periarticular injection of bupivacaine, fentanyl, and methylprednisolone in total knee arthroplasty: A prospective, randomized trial. J. Arthroplast. 2010, 25, 851–857. [Google Scholar] [CrossRef] [PubMed]
- Martin, N.J.; Padmanabhan, V.; Pindis, J.J. Efficacy of Periarticular Cocktail Injection in Rheumatoid Patients Undergoing Total Knee Replacement. Indian J. Orthop. 2020, 54, 811–822. [Google Scholar] [CrossRef]
- Jensen, M.P.; Karoly, P.; Braver, S. The measurement of clinical pain intensity: A comparison of six methods. Pain 1986, 27, 117–126. [Google Scholar] [CrossRef]
- Kapenda Lungonyonyi, R.; Bleuze, P.; Boutière, J.P. Local Anesthetic Systemic Toxicity After Local Infiltration Analgesia Following a Total Knee Arthroplasty. Cureus 2022, 14, e26224. [Google Scholar] [CrossRef]
- Hussain, N.; Brull, R.; Sheehy, B.; Dasu, M.; Weaver, T.; Abdallah, F.W. Does the addition of iPACK to adductor canal block in the presence or absence of periarticular local anesthetic infiltration improve analgesic and functional outcomes following total knee arthroplasty? A systematic review and meta-analysis. Reg. Anesth. Pain Med. 2021, 46, 713–721. [Google Scholar] [CrossRef]
- YaDeau, J.T.; Cushner, F.D.; Westrich, G.; Lauzadis, J.; Kahn, R.L.; Lin, Y.; Goytizolo, E.A.; Mayman, D.J.; Jules-Elysee, K.M.; Gbaje, E.; et al. What Is the Role of a Periarticular Injection for Knee Arthroplasty Patients Receiving a Multimodal Analgesia Regimen Incorporating Adductor Canal and Infiltration Between the Popliteal Artery and Capsule of the Knee Blocks? A Randomized Blinded Placebo-Controlled Noninferiority Trial. Anesth. Analg. 2024, 138, 1163–1172. [Google Scholar] [CrossRef]
Variables | Periarticular Multimodal Drug Injection | ||
---|---|---|---|
No | Yes | p Value | |
N | 88 | 39 | |
Age (years) | 71.8 ± 9.0 | 71.7 ± 6.4 | 0.949 |
Male sex | 22 (25.0) | 12 (30.8) | 0.498 |
Body mass index (kg/m2) | 28.5 ± 4.5 | 28.0 ± 3.9 | 0.596 |
Smoking | 3 (3.4) | 2 (5.1) | 0.646 |
Diabetes | 27 (30.7) | 13 (33.3) | 0.767 |
Hypertension | 59 (67.0) | 25 (64.1) | 0.746 |
Chronic kidney disease | 24 (27.3) | 8 (20.5) | 0.418 |
Preoperative analgesics † | 68 (77.3) | 30 (76.9) | 0.965 |
Operation time (minutes) | 135 ± 45 | 140 ± 34 | 0.600 |
Postoperative treatment | |||
Anti-platelet ‡ | 72 (81.8) | 35 (89.7) | 0.258 |
Anti-coagulants § | 15 (17.0) | 4 (10.3) | 0.322 |
Patient-controlled analgesia | 79 (89.8) | 34 (87.2) | 0.667 |
Variables | PMDI | ||
---|---|---|---|
No | Yes | p Value | |
PCA consumption in the first 24 h (mL) | 155 ± 44 | 126 ± 47 | 0.009 |
Early mobilization within 24 h | 38 (43.2) | 33 (84.6) | <0.001 |
Length of hospital stay (days) | 6.2 ± 1.3 | 5.4 ± 1.0 | 0.001 |
Pain scores | |||
VAS before operation | 1.7 ± 0.9 | 1.6 ± 0.7 | 0.523 |
VAS after operation | 3.9 ± 2.4 | 3.6 ± 2.2 | 0.451 |
VAS postoperative day 1 | 3.9 ± 2.0 | 3.5 ± 1.9 | 0.414 |
VAS postoperative day 3 | 3.9 ± 2.6 | 3.7 ± 2.2 | 0.677 |
Side effects | |||
Constipation | 35 (39.8) | 14 (35.9) | 0.679 |
Nausea/Vomiting | 28 (31.8) | 10 (25.6) | 0.483 |
Urine retention | 6 (6.8) | 7 (17.9) | 0.056 |
Skin itching/Allergy | 5 (5.7) | 7 (17.9) | 0.029 |
Dizziness | 7 (8.0) | 5 (12.8) | 0.387 |
Delirium | 1 (1.1) | 1 (2.6) | 0.551 |
Use of analgesics 3 months after operation † | 43 (48.9) | 17 (43.6) | 0.583 |
β Coefficient (95% CI) | p | |
---|---|---|
Independent variable: PMDI | ||
Model 1 | −28.7 (−49.9, −7.4) | 0.009 |
Model 2 | −29.9 (−51.1, −8.6) | 0.006 |
Model 3 | −29.9 (−51.9, −7.9) | 0.008 |
Odds Ratio (95% CI) | p | |
---|---|---|
Independent variable: PMDI | ||
Model 1 | 7.237 (2.752, 19.028) | <0.001 |
Model 2 | 7.312 (2.772, 19.283) | <0.001 |
Model 3 | 8.263 (3.041, 22.453) | <0.001 |
β Coefficient (95% CI) | p | |
---|---|---|
Independent variable: PMDI | ||
Model 1 | −0.746 (−1.196, −0.296) | 0.001 |
Model 2 | −0.757 (−1.210, −0.304) | 0.001 |
Model 3 | −0.705 (−1.158, −0.252) | 0.003 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Chen, J.-J.; Wu, Y.-C.; Hung, C.-Y.; Lee, C.-H.; Wang, J.-S. Effects of Periarticular Multimodal Drug Injection on Pain Control, Early Mobilization, and Length of Hospital Stay in Patients Undergoing Total Knee Arthroplasty. Life 2024, 14, 1018. https://doi.org/10.3390/life14081018
Chen J-J, Wu Y-C, Hung C-Y, Lee C-H, Wang J-S. Effects of Periarticular Multimodal Drug Injection on Pain Control, Early Mobilization, and Length of Hospital Stay in Patients Undergoing Total Knee Arthroplasty. Life. 2024; 14(8):1018. https://doi.org/10.3390/life14081018
Chicago/Turabian StyleChen, Jian-Jiun, Yun-Che Wu, Chuan-Yu Hung, Cheng-Hung Lee, and Jun-Sing Wang. 2024. "Effects of Periarticular Multimodal Drug Injection on Pain Control, Early Mobilization, and Length of Hospital Stay in Patients Undergoing Total Knee Arthroplasty" Life 14, no. 8: 1018. https://doi.org/10.3390/life14081018
APA StyleChen, J.-J., Wu, Y.-C., Hung, C.-Y., Lee, C.-H., & Wang, J.-S. (2024). Effects of Periarticular Multimodal Drug Injection on Pain Control, Early Mobilization, and Length of Hospital Stay in Patients Undergoing Total Knee Arthroplasty. Life, 14(8), 1018. https://doi.org/10.3390/life14081018