Pre-emptive injection of peri-articular-multimodal drug for post-operative pain management in total knee arthroplasty: a double-blind randomized clinical trial

Motififard, Mehdi; Omidian, Ali; Badiei, Sajad

doi:10.1007/s00264-016-3357-2

Cited by 28 publications

(28 citation statements)

References 20 publications

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“…In fact, some researchers even suggest that using periarticular or intra‐articular infiltration analgesia without nerve block could provide good postoperative pain relief results . Recently, multiple studies have shown the pain relief efficacy of multimodal local injection of analgesics for TKA . Choosing an optimum drug composition for local injection, therefore, should be thoroughly considered as a meaningful procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Anesthetics such as ropivacaine and bupivacaine, along with epinephrine, are most commonly combined for use in local infiltration analgesia . Use of NSAIDs and morphine for the local injection has been reported to reduce postoperative pain . The use of corticosteroids has effects that cause concern in total joint surgery, such as a suppressive effect in prosthetic joint infection .…”

Section: Discussionmentioning

confidence: 99%

“…Periarticular or intra‐articular injection of a multimodal cocktail is a safe and cost‐effectiveness measure. It may inhibit inflammation in the operated tissue and decrease pain . Although the analgesic effect of various drug combinations for local injection in TKA has been well documented, the gold standard for drug combination has not yet been well established.…”

Section: Introductionmentioning

confidence: 99%

“…It may inhibit inflammation in the operated tissue and decrease pain. [6][7][8][9] Although the analgesic effect of various drug combinations for local injection in TKA has been well documented, the gold standard for drug combination has not yet been well established. This injection mixture usually contains multiple compositions with a base of local anesthetics and epinephrine, and is combined with other drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and opioids.…”

Section: Introductionmentioning

confidence: 99%

“…This injection mixture usually contains multiple compositions with a base of local anesthetics and epinephrine, and is combined with other drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and opioids. [5][6][7][8][9][10] Whether those compositions are all necessary is yet to be proven.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Additional Corticosteroid in a Multimodal Cocktail for Postoperative Analgesia Following Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

et al. 2019

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Background Local injection of a multimodal cocktail including corticosteroid is commonly used for postoperative pain following total knee arthroplasty (TKA). However, it is inconclusive whether additional corticosteroid is beneficial. This meta‐analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy of an additional, local injection of corticosteroid in terms of pain relief and knee function recovery after TKA. Methods RCTs in electronic literature databases including PubMed, Web of Science, Embase, and Cochrane Library were systematically searched. Of 1,628 records identified, 9 RCTs involving 727 knees were eligible for data extraction and meta‐analysis. Results Local injection of a multimodal cocktail including corticosteroid did not contribute to pain relief within 12 hours postoperatively (P > 0.05). However, from 24 hours to 72 hours, it significantly decreased pain scores (P < 0.05, all) at rest and reduced total rescue opioid consumption postoperatively (P < 0.05). Knee range of motion (ROM) was improved at postoperative day 1 (POD1) and POD2 (P < 0.05), and hospital stay (P < 0.05) was shortened after local injection of corticosteroid. However, the other outcomes, including knee ROM after POD2, C‐reactive protein level, Knee Society score, postoperative nausea and vomiting, and wound complication occurrences, were not significantly different (P > 0.05, all). Conclusions Additional corticosteroid added to a multimodal cocktail improved postoperative pain, enhanced knee functional recovery, and shortened hospital stays following TKA, but local injection of corticosteroids had no effect on reducing nausea and vomiting based on our outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%