Effects of periarticular injection on analgesic effects and NSAID use in total knee arthroplasty and total hip arthroplasty

Abstract

OBJECTIVES:This study examined periarticular multimodal drug injection and the use of nonsteroidal anti-inflammatory drugs for an early analgesic effect after total knee arthroplasty and total hip arthroplasty. Patient satisfaction and benefits from the treatment were also assessed.METHODS:A total of 110 patients who were scheduled to undergo total knee arthroplasty and 86 patients who were scheduled to undergo total hip arthroplasty were divided into two groups, the study group and the control group. The study group received a periarticular multimodal drug injection during surgery. The control group received an equal volume of normal saline. All patients received an analgesia pump and a moderate dose of nonsteroidal anti-inflammatory drugs. Resting and motion Numeric Rating Scale scores, the Western Ontario and McMaster Universities Arthritis Index, knee or hip joint range of motion, length of postoperative hospital stay, patient satisfaction, total nonsteroidal anti-inflammatory drug consumption and side effects were recorded.RESULTS:Both study groups exhibited significant improvement in pain Numeric Rating Scale scores during rest and exercise several days after the surgery. The range of joint motion was greater in the study group, and the length of postoperative hospital stay was shorter than that in the control group. Patients in the study group consumed fewer nonsteroidal anti-inflammatory drugs and reported greater satisfaction with surgery.CONCLUSION:Intraoperative periarticular multimodal drug injection significantly relieved pain after surgery and reduced nonsteroidal anti-inflammatory drug consumption. These patient had a better postoperative experience, including satisfaction and rehabilitation.

Intraoperative periarticular injection can alleviate the inflammatory response and enhance joint function recovery after hip arthroplasty in elderly patients with osteoporotic femoral neck fractures

“…The results of the present study also indicated that PAI contributed to significantly better functional recovery [ 29 ] which may be related to reductions in the postoperative inflammatory response and pain level.…”

“…[ 18 , 27 , 28 ] PAI can also reduce opioid consumption, which results in a better postoperative experience, including improved satisfaction and rehabilitation. [ 29 , 30 ] However, research to date has largely focused on the use of PAI during hip arthroplasty performed as treatment for osteoarthritis or femoral head necrosis, and the effects of PAI in elderly patients undergoing THA for osteoporotic femoral neck fractures remained unknown. Therefore, this study explored changes in plasma inflammatory markers, which may provide a reference for monitoring complications such as infections after THA performed with intraoperative PAI, in elderly patients with osteoporotic femoral neck fractures.…”

Procedure-specific acute pain trajectory after elective total hip arthroplasty: systematic review and data synthesis

“…All studies mentioning LIA reported intraoperative periarticular, capsular and subcutaneous infiltration, whereas some added to that approach a postoperative intra-articular infiltration, 16,18,19,47,66 a postoperative periarticular infiltration, 46 or a periarticular infiltration with catheters. 15,73 Only long-acting local anaesthetics were used as the basis for LIA, those being ropivacaine, [15][16][17][18][19][20]30,39,46,47,49,50,52,60,73,[77][78][79]85 bupivacaine, 40 or levobupivacaine. 32,58,66 Supplementary Table S1 summarises the LIA techniques used.…”

The efficacy of intraoperative periarticular injection in Total hip arthroplasty: a systematic review and meta-analysis

“…PAI has been widely studied for its potential efficacy in THA surgery. The potential benefits include pain relief during the acute postoperative period, improved functional recovery, reduced amount of opioid consumption, shortened length of hospital stay, lower rate of nausea and vomiting [5–16]. Jiang et al [25] conducted a meta-analysis of using periarticular multimodal drug injection (PMDI) in TKA or THA patients and concluded the PMDI group was associated with improved pain relief, less opioid consumption, better range of motion and lower rate of nausea and vomiting.…”

“…This method usually consists of a local anesthetics of amide derivatives (eg, ropivacaine, bupivacaine, levobupivacaine, ropivacaine) and/or corticosteroids, opioids, epinephrine, nonsteroidal anti-inflammatory drugs and dilution with normal saline. In terms of its efficacy, several studies have validated the benefit of PAI on post-operative pain relief [5–9], while some other studies did not find an improvement in pain control [10–15]. Therefore, the efficacy of PAI in THA remains inconclusive.…”