Comparison of 2 Methods of Local Anesthetic-Based Injection as Part of a Multimodal Approach to Pain Management After Total Knee Arthroplasty

Tietje, Teya; Davis, April; Rivey, Michael P.

doi:10.1177/0897190014544815

Cited by 7 publications

(6 citation statements)

References 36 publications

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“…PAI group showed a statistically significant reduction in postoperative VAS pain scores in a previous study [17], which positively correlated with NRS pain scores in our study [26]. In a retrospective study [27], Tietje demonstrated that patients receiving PAI of local anaesthetics in TKA had a noticeable decrease in length of hospital stay and incidence of postoperative nausea and vomiting when compared to patients receiving IAI. In the early period after surgery, it is pain that mainly accounts for patients hospitalization [2].…”

Section: Discussionsupporting

confidence: 77%

The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial

et al. 2020

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Background: As an essential component of multimodal analgesia approaches after total knee arthroplasty (TKA), local infiltration analgesia (LIA) can be classified into peri-articular injection (PAI) and intra-articular injection (IAI) according to administration techniques. Currently, there is no definite answer to the optimal choice between the two techniques. Our study aims to investigate analgesic efficacy and safety of PAI versus IAI in patients receiving simultaneous bilateral TKA. Methods: This randomized controlled trial was conducted from February 2017 and finished in July 2018. Sixty patients eligible for simultaneous bilateral total knee arthroplasty were randomly assigned to receive PAI on one side and IAI on another. Primary outcomes included numerical rating scale (NRS) pain score at rest or during activity at 3 h, 6 h, 12 h, 24 h, 48 h, and 72 h following surgery. Secondary outcomes contained active or passive range of motion (ROM) at 1, 2, and 3 days after surgery, time to perform straight leg raise, wound drainage, operation time, and wound complications. Results: Patients experienced lower NRS pain scores of the knee receiving PAI compared with that with PAI during the first 48 h after surgery. The largest difference of NRS pain score at rest occurred at 48 h (PAI: 0.68, 95%CI[0.37, 0.98]; IAI: 2.63, 95%CI [2.16, 3.09]; P < 0.001); and the largest difference of NRS pain score during activity also took place at 48 h (PAI: 2.46, 95%CI [2.07, 2.85]; IAI: 3.90, 95%CI [3.27, 4.52]; P = 0.001). PAI group had better results of range of motion and time to perform straight leg raise when compared with IAI group. There were no differences in operation time, wound drainage, and wound complication. Conclusion: PAI had the superior performance of pain relief and improvement of range of motion to IAI. Therefore, the administration technique of peri-articular injection is recommended when performing local infiltration analgesia after total knee arthroplasty. Trial registration: The trial was retrospectively registered in the Chinese Clinical Trial Registry as ChiCTR1800020420 on 29th December, 2018.

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Section: Discussionsupporting

confidence: 77%

The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial

et al. 2020

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“…These injections have been effective in reducing pain and speeding recovery. 4 A study comparing intraarticular injections of 0.25% to 0.50% bupivacaine with periarticular injections of ropivacaine, ketorolac, epinephrine, and clonidine found a significant decrease in hospital length of stay and postoperative nausea and vomiting compared with intraarticular injections. 4…”

Section: Discussionmentioning

confidence: 99%

“…These injections are widely considered to be safe and effective for reducing postoperative opioid requirements and decreasing time to recov-ery through early mobilization. [1][2][3][4] As with any injection, there exists the potential for injury to the local vascular structures. Among the potential complications is the possibility of forming an arteriovenous fistula as a result of puncture of an artery and vein in close proximity.…”

mentioning

confidence: 99%

Arteriovenous Fistula Formation After Intra-articular Injection Following Total Joint Arthroplasty

Post¹,

Ong²,

Orozco³

2016

Orthopedics

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Intra-articular joint capsule injection is a common method used to control postoperative pain as a result of primary total knee arthroplasty (TKA). It is generally considered a safe practice and is highly effective in reducing the need for postoperative opioid administration as well as decreasing recovery time through early mobilization. However, any injection into the posterior knee space has the potential to injure the vascular structures surrounding the knee. Iatrogenic formation of an arteriovenous fistula is a rare complication after TKA, and there are no reported cases of arteriovenous fistula formation as a direct result of intra-articular injection. This case report describes this complication that occurred several days after TKA. The patient had acute pain and swelling in the treated leg. An arteriovenous fistula of the popliteal artery and vein was identified with bilateral Doppler ultrasound and confirmed by angiogram. The most likely inciting event for the formation of the arteriovenous fistula was intra-articular injection of bupivacaine, which likely pierced the popliteal artery and vein, allowing the formation of the patent channel. The patient was treated successfully with stent placement through interventional radiology. Orthopedic surgeons performing intra-articular injections of the knee should refamiliarize themselves with the anatomy and location of the popliteal artery, use smaller-gauge needles, and aspirate the syringe before the injection to decrease the risk of iatrogenic damage to the vasculature or fistula formation. [Orthopedics.2016; 39(5):e976-e979.].

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“…T otal knee arthroplasty (TKA) is performed with the goals to restore mobility, return an individual to activities of daily living, and improve quality of life. 1 However, a substantial number of patients experience severe pain following a TKA, and management of the pain represents a significant clinical problem. 2 Nearly 80% of patients undergoing surgery report moderate to extreme pain in the first 2 weeks following surgery.…”

mentioning

confidence: 99%

“…The efficacy and safety of an intraoperative periarticular (IOPA) injection approach containing several different combinations of ropivacaine hydrochloride, ketorolac tromethamine, epinephrine, and clonidine has been established. [1][2][3][4][5][6][7] However, there is no single recommended protocol for periarticular injections, and the analgesics incorporated, doses used, and administration techniques are variable. 3 The purpose of the present study was to compare the effectiveness and safety of liposomal bupivacaine with an IOPA injection following TKA.…”

mentioning

confidence: 99%

Comparison of Intraoperative Periarticular Injections versus Liposomal Bupivacaine as Part of a Multimodal Approach to Pain Management in Total Knee Arthroplasty

2016

Self Cite

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Comparison of 2 Methods of Local Anesthetic-Based Injection as Part of a Multimodal Approach to Pain Management After Total Knee Arthroplasty

Abstract: The use of IOPA injections containing ropivacaine, epinephrine, ketorolac, and clonidine during TKA offered some benefit over IOIA infusions containing 0.25% to 0.5% bupivacaine at our institution.

Cited by 7 publications

References 36 publications

The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial

The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial

Arteriovenous Fistula Formation After Intra-articular Injection Following Total Joint Arthroplasty

Comparison of Intraoperative Periarticular Injections versus Liposomal Bupivacaine as Part of a Multimodal Approach to Pain Management in Total Knee Arthroplasty

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