Intraosseous Morphine Decreases Postoperative Pain and Pain Medication Use in Total Knee Arthroplasty: A Double-Blind, Randomized Controlled Trial

Brozovich, Ava; Incavo, Stephen J.; Lambert, Bradley S.; Sullivan, Thomas C.; Wininger, Austin E.; Clyburn, Terry A.; Taraballi, Francesca; Park, Kwan J.

doi:10.1016/j.arth.2021.10.009

Cited by 13 publications

(5 citation statements)

References 43 publications

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“…The significantly better results witnessed in the PMD-I group may potentially be attributable to the localized absorption and localized reducing the inflammatory response of the analgesic cocktail mixture. In a previous study by Brozovich et al, morphine was injected into the femur via intraosseous infusion using a catheter, and it was found that the group of patients receiving morphine injections after knee surgery had statistically significant lower postoperative pain, without an increase in side effects related to morphine use than that experienced by the control group [ 13 ]. Also, the study of Ali Akın Ugras found the rising of local intraarticular inflammatory marker (IL-6) in TKA patients correlated with slower recovery but not correlated with a systemic inflammatory marker which suggests that the early recovery was affected by the local inflammatory response than the systemic responds [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite its use, the optimal location and formulation of the mixture remain inconclusive and subject to ongoing study. A retrospective study found that patients receiving intraosseous morphine through a catheter post-TKA exhibited significantly lower postoperative pain compared to the control group [ 13 ]. In an effort to further reduce local inflammatory responses, we hypothesize that a combined periarticular and intraosseous multimodal injection (PMD-I) technique could more effectively alleviate postoperative pain than PMD alone, without increasing costs or incorporating additional techniques.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of a Combined Periarticular and Intraosseous Multimodal Analgesic Injection Technique in Simultaneous Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial

Ploynumpon,

Wilairatana,

Chomposang

2024

Cureus

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Introduction Early postoperative pain poses a challenge for surgeons to manage after total knee arthroplasty (TKA). Various techniques have been employed to optimize pain reduction, including Periarticular Multimodal Analgesia (PMA), recognized as a safe and effective method. Our study aims to enhance PMA through a combined intraosseous injection (PMA-I) and compare it with standard PMA. Methods Forty patients undergoing simultaneous bilateral TKA surgery were enrolled. Patients were randomized to receive PMA-I on one side of the knee, while the contralateral knee received standard PMA. Pain scores, bleeding, and range of motion (ROM) were assessed in both groups. Results The PMA-I group demonstrated statistically significant lower visual analog scale (VAS) scores at all postoperative time points, except at 48 hours, where the difference was not statistically significant. Postoperative bleeding and ROM did not significantly differ between groups. Conclusion PMA-I demonstrated both statistically and clinically significant reduction in early post-TKA pain, without additional costs, providing a technique that can be used to optimize postoperative pain control in TKA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of a Combined Periarticular and Intraosseous Multimodal Analgesic Injection Technique in Simultaneous Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial

Ploynumpon,

Wilairatana,

Chomposang

2024

Cureus

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“…With drop out rate 20% --N will be 20 for each arm [3] Research protocol -This is a randomized, double-blinded controlled trial study. The study protocol must be approved by the Institutional Review Board, and all subjects must give written informed consent to participate in the study.…”

Section: N=16mentioning

confidence: 99%

Study protocol for comparison of post-operative pain between intraosseous multimodal injection and periarticular multimodal injection in Simultaneous Bilateral Total Knee Arthroplasty – A Randomized Controlled Trial

ploynumpon

Wilairatana²,

Chompoosang³

2023

Preprint

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Abstraction Background Total knee arthroplasty (TKA) was the procedure which is preform by orthopedic surgeons in end stage osteoarthritis knee patients who fail conservative treatment. Periarticular analgesia is one of the effective and safe technique used to reduce pain after surgery. However, the location and formula of the mixture have not yet been controversy. Recently, there were study comparing intraosseous analgesic injection which provide significant postoperative pain relief than control group. So the authors conducted this study to compare between periarticular and intraosseous analgesic injection in simultaneous bilateral total knee arthroplasty patients. Method The study is a two-arm, double-blinded,randomised controlled trial with Twenty-six patients(52 knees)who undergone simultaneous bilateral total knee arthroplasty.Primary outcome is post operative pain at 12 hour ,24hour and 48 hour by using Visual analog scale for assessment. Secondary outcome are postoperative range of motion at 24 and 48 hour, post operative blood loss and post operative complication. Discussion While periarticular analgesic is the standard practice .intraosseous analgesic injection is potential route for control post operative pain after total knee arthroplasty surgery. This study can offer better alternative route for analgesic injection.

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“…And as it cools it establishes a permanent bone-hard barrier to subchondral bone reinnervation. In the presence of osteoporosis, common in OA patients, there should be no need for the specialized needles used routinely for bone marrow aspiration [15]. Injection of a local anesthetic prior to the PMMA, sural nerve block, or regional anesthesia should permit the procedure itself to be mostly painless.…”

Section: Why It Matters That Oa Pain Is Subserved By Intrinsic Bone A...mentioning

confidence: 99%

Pain in Osteoarthritis: Driven by Intrinsic Rather Than Extrinsic Joint Afferents and Why This Should Impact Treatment

Devor¹

2023

Preprint

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Pain in osteoarthritis (OA) results from erosion of joint cartilage, resulting in bone contacting bone without an intervening cushion. The periosteum, including its nociceptive innervation, ends at the border of the cartilage meaning that there is no extrinsic neuronal pathway between the opposing denuded bone surfaces to carry a bone-on-bone pain signal to the brain. The pain signaling pathway must therefore originate in nociceptive sensory endings within the subchondral bone itself. Selective ablation of this intrinsic nerve pathway, using any of a variety of approaches, is expected to permanently eliminate OA pain.

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Intraosseous Morphine Decreases Postoperative Pain and Pain Medication Use in Total Knee Arthroplasty: A Double-Blind, Randomized Controlled Trial

Cited by 13 publications

References 43 publications

Efficacy of a Combined Periarticular and Intraosseous Multimodal Analgesic Injection Technique in Simultaneous Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial

Efficacy of a Combined Periarticular and Intraosseous Multimodal Analgesic Injection Technique in Simultaneous Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial

Study protocol for comparison of post-operative pain between intraosseous multimodal injection and periarticular multimodal injection in Simultaneous Bilateral Total Knee Arthroplasty – A Randomized Controlled Trial

Pain in Osteoarthritis: Driven by Intrinsic Rather Than Extrinsic Joint Afferents and Why This Should Impact Treatment

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