Intra-articular morphine and/or bupivacaine in the management of pain after total knee arthroplasty

Mauerhan, David R.; Campbell, Michael; Miller, Joshua S.; Mokris, Jeffrey G.; Gregory, Alexia M.; Kiebzak, Gary M.

doi:10.1016/s0883-5403(97)90178-9

Cited by 92 publications

(83 citation statements)

References 33 publications

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“…PAI under direct vision provided local anesthetic tissue entrapment and reduced medication discharge through the evacuation drain or skin incision. Furthermore, two injections were given, and the anesthetic doses were higher than in other studies [3,5,17,19]. Moreover, the addition of adrenaline to local anesthetics could slow ropivacaine release in the vascular system and prolong its local action.…”

Section: Discussionmentioning

confidence: 99%

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Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Chaumeron

Audy

Drolet

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background The postoperative analgesic potential of periarticular anesthetic infiltration (PAI) after TKA is unclear as are the complications of continuous femoral nerve block on quadriceps function. Questions/purposes We asked (1) whether PAI provides equal or improved postoperative pain control in comparison to a femoral nerve block in patients who have undergone TKA; and (2) if so, whether PAI improves early postoperative quadriceps control and facilitates rehabilitation. Methods We randomized 60 patients to receive either PAI or femoral nerve block. During the first 5 days after TKA, we compared narcotic consumption, pain control, quadriceps function, walking distance, knee ROM, capacity to perform a straight leg raise, and active knee extension. Medication-related side effects, complications, operating room time, and hospitalization duration were compared.

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Section: Discussionmentioning

confidence: 99%

“…2). Some authors have investigated the benefits of local analgesia after TKA (Table 4) [3,19,22]. Except for the study by Badner et al [3], studies using intraarticular injections alone failed to show a reduction of narcotic consumption after surgery [5,16,19,22].…”

Section: Discussionmentioning

confidence: 99%

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Chaumeron

Audy

Drolet

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…When comparing intraoperative periarticular injections with intraarticular injections given after closure of the capsule, better pain scores are generally found in studies using periarticular injections [12,15,30,36]. With the exception of a few studies showing minimal improved pain [24,32], the majority of studies using intraarticular injections showed no improvement in pain scores postoperatively [3,5,15,19,27]. Hence, most studies on this topic indicate that there is an advantage to direct injection of the soft tissues over simple intraarticular injection.…”

Section: Discussionmentioning

confidence: 99%

The Chitranjan Ranawat Award: Periarticular Injections and Femoral & Sciatic Blocks Provide Similar Pain Relief After TKA: A Randomized Clinical Trial

Spangehl

Clarke

Hentz

et al. 2015

Clinical Orthopaedics &Amp; Related Research

128

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Background Two of the more common methods of pain management after TKA are peripheral nerve blocks and intraarticular/periarticular injections. However, we are not aware of any study directly comparing the commonly used combination of a continuous femoral block given with a single-shot sciatic block with that of a periarticular injection after TKA. Questions/purposes This randomized clinical trial compared a combined femoral and sciatic nerve block with periarticular injection as part of a multimodal pain protocol after total knee arthroplasty with respect to (1) pain; (2) narcotic use; (3) quadriceps function and length of stay; and (4) peripheral nerve complications. Methods One hundred sixty patients completed randomization into two treatment arms: (1) peripheral nerve blocks (PNB; n = 79) with an indwelling femoral nerve catheter and a single shot sciatic block; or (2) periarticular injection (PAI; n = 81) using ropivacaine, epinephrine, ketorolac, and morphine. All patients received standardized general anesthesia and oral medications. The primary outcome was postoperative pain, on a 0 to 10 scale, measured on the afternoon of postoperative day 1 (POD 1). Secondary outcomes were narcotic use, quadriceps function, length of stay, and peripheral nerve complications. Results Mean pain scores on the afternoon of POD 1 were not different between groups (PNB group: 2.9 [SD 2.4]; PAI group: 3.0 [SD 2.2]; 95% confidence interval, À0.8 to 0.6; p = 0.76). Mean pain scores taken at three times points on POD 1 were also similar between groups. Hospital length of stay was shorter for the PAI group (2.44 days [SD 0.65] versus 2.84 days [SD 1.34] for the PNB group; p = 0.02). Narcotic consumption was higher the day of surgery for the PAI group (PAI group: 11.7 mg morphine equivalents [SD 13

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“…A pesar de que los opioides intraarticulares han demostrado ser efectivos en cirugía de artroscopia de rodilla 112,113 , no son eficaces para el control del dolor postoperatorio de PTR.…”

Section: Analgesia Intraarticularunclassified