Multimodal Cocktail Injection relieves Postoperative Pain and improves Early Rehabilitation following Total Knee Replacement: A Prospective, Blinded and Randomized Study

Abstract

Objectives: An effective postoperative analgesia following total knee arthroplasty (TKA) would shorten the rehabilitation period and improve patient satisfaction. The primary objective of the present study is to test the hypothesis that intraoperative multimodal cocktail injection can significantly reduce the consumption of analgesics and duration of time required to perform straight-leg raise, and improve range of motion (ROM) and patient satisfaction rate following TKA. Materials and methods:A total of 126 osteoarthritic knees in patients with a mean age of 68 years (58-80 years) scheduled for primary TKA were prospectively randomized into three groups. Patients in all three groups received the same anesthesia and postprocedure pain control and rehabilitation protocol. The assessor was blind with regard to multimodal cocktail injection for the duration of study. Assessment was done preoperatively at 1, 2, 3, and 4 postoperative days, and at 1, 2, and 3 months postoperatively. The primary outcome was function measured with Western Ontario and McMaster Universities Arthritis Index. Pain and patient satisfaction rate were established using visual analog scale and Likert scale respectively. Consumption of analgesic during the postoperative days (1-4 days), hospital stay, and ROM were recorded and evaluated. Outcome measures were critically analyzed. The level of significance was set at <0.05. Results:Pain, functional scores, and satisfaction rates were significantly better in cocktail group than in the control group (p < 0.05). Consumption of nonsteroidal anti-inflammatory drugs was significantly lower in groups with multimodal cocktail injection than in the control group (p < 0.05). Mean follow-up time was 3 months with no patient lost to follow-up. No complications related to the infiltration of the local anesthetic and/or steroids were observed. Conclusion:Multimodal cocktail injection offered improved postoperative pain control, thus facilitating early rehabilitation.

Proximal fibular resection improves knee biomechanics and enhances tibial stress fracture healing in patients with osteoarthritis with varus deformity: a prospective, randomized control analysis

“…The delay in rehabilitation was due to inadequate pain relief owing to delayed union and repeated surgical intervention for established pseudarthrosis. During the course of study, authors noticed that post-surgical pain delayed early rehabilitation and thus negatively affected patients' satisfaction rate and functional outcomes [37]. In the current study, we started to use PFR as an additional procedure to decompress the medial compartment more efficiently.…”

Post-operative pain management using local infiltration analgesia (LIA) in total knee arthroplasty (TKA): A prospective study

“…Morphine acts on opiate receptors and reduces transmission of pain signals and cefuroxime acts as an antibiotic cover reducing chances of post-op infection. Methylprednisolone acts by attenuating the neuroendocrine stress response, inhibiting pro inflammatory pathways and by counteracting vasodilatory effects of prostaglandins [21][22][23] . Usage of LIA is also found to reduce opioid utilization and its systemic adverse effects to patients by the long lasting effects of bupivacaine which is one of the components in the Ranawat Cocktail (ROC) regimen.…”

“…All these beneficial effects of LIA cocktail ensures that the TKA patients have a reduced hospital stay thereby reducing their chances of nosocomial infections due to signicant reduction in post-op pain and also early and adequate mobilization [24] . The use of LIA has also been linked with better patient satisfaction, decreased opioid consumption and reduced operative site complications [14,22,25] . The main disadvantages of LIA is usually seen due to the high doses of local anaesthetic used in the cocktail and is associated with cardiotoxicity and CNS toxicity in some elderly patients which may be lethal and are thus relative contraindications in such patients [26] .…”