Comparason of Peri-Articular Multimodal Drug Injection with Femoral and Sciatic Nerve Block after Total Knee Arthroplasty

DOI: 10.4236/ojo.2012.24029   PDF   HTML     4,690 Downloads   8,892 Views   Citations

Abstract

Good perioperative analgesia following total knee arthroplasty facilitates rehabilitation and may reduce hospital stay. We present the patient analgesic requirements and rehabilitation of a prospective single surgeon series after the introduction of a multimodal drug injection during his total knee arthroplasty. Basic epidemiological data as well as analgesic, antiemetic requirements and time to straight leg raised was collected on 27 consecutive patients (group 1) whom received the multimodal drug injection, consisting of levobupivacaine, ketorolac and adrenaline at the time of their total knee arthroplasty under spinal anaesthesia. Their rehabilitation was compared to a retrospective review of patients who were case matched by age and sex (group 2n = 26), whom had received the unit standard of spinal anaesthetic and a femoral and sciatic block at the time of their operation. Patients in group 1 had significantly lower analgesic and antiemetic requirements than group 2. Group 1 also had a significantly shorter hospital stay. We have demonstrated that periarticular multimodal drug injection can improve perioperative analgesia and mobilisation following total knee arthroplasty as well as reducing opioid requirements and side effects.

Share and Cite:

C. Arthur, A. Wood, C. Leeson-Payne and S. Breusch, "Comparason of Peri-Articular Multimodal Drug Injection with Femoral and Sciatic Nerve Block after Total Knee Arthroplasty," Open Journal of Orthopedics, Vol. 2 No. 4, 2012, pp. 155-158. doi: 10.4236/ojo.2012.24029.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] A. S. Malik, O. Boyko, N. Atkar and W. F. Young, “A Comparative Study of MR Imaging Profile of Titanium Pedicle Screws,” Acta Radiologica, Vol. 42, No. 3, 2001, pp. 291-293. doi:10.1080/028418501127346846
[2] A. Buvanendran, J. S. Kroin, K. J. Tuman, T. R. Lubenow, D. Elmofty, M. Moric and A. G. Rosenburg, “Effects of Perioperative Administration of a Selective Cycloxygenase 2 Inhinitor on Pain Management and Recovery of Function after Knee Replacement,” Journal of the American Medical Association, Vol. 290, No. 18, 2003, pp. 2411-2418. doi:10.1001/jama.290.18.2411
[3] F. J. Singelyn, M. Deyaert, D. Joris, E. Pendeville and J. M. Gouverneur, “Effects of Intravenous Patient-Controlled Analgesia with Morphine, Continuous Epidural Analgesia, and Continuous Three-in-One Block on Postoperative Pain and Knee Rehabilitation after Unilateral Total Knee Arthroplasty,” Anaesthesia and Analgesia, Vol. 87, No. 1, 1998, pp. 88-92.
[4] X. Capdevila, Y. Barthelet, P. Biboulet, Y. Ryckwaert, J. Rubenovitch and F. d’Athis, “Effects of Perioperative Analgesic Techniques on the Surgical Outcome and Duration of Rehabilitation after Major Knee Surgery,” Anesthesiology, Vol. 91, No. 1, 1999, pp. 8-15. doi:10.1097/00000542-199907000-00006
[5] E. Wit and J. McClure, “Statistics for Microarrays: Design, Analysis and Inference,” 5th Edition, John Wiley & Sons Ltd., Chichester, 2004.
[6] S. A. Strassels, C. Chen and D. B. Carr, “Postoperative Analgesia: Economics, Resourse Use and Patient Satisfaction in an Urban Teaching Hospital,” Anaesthesia and Analgesia, Vol. 94, No. 1, 2002, pp. 130-137.
[7] H. K. Parvatanei, V. P. Shah, H. Howard, N. Cole, A. S. Ranawat and C. S. Ranawat, “Controlling Pain after Total Hip and Knee Arthroplasty Using a Multimodal Protocol with Local Periarticular Injections,” Journal of Arthroplasty, Vol. 22, No. 6, 2007, pp. 33-38. doi:10.1016/j.arth.2007.03.034
[8] K. Toftdahl, L. Nikolajesen, V. Haraldsted, F. Madasen, E. K. Tonnesen and K. Soballe, “Comparison of Periand Intraarticular Analgesia with Femoral Nerve Block after Total Knee Arthroplasty. A Randomised Clinical Trial,” Acta Orthopaedica, Vol. 78, No. 2, 2007, pp. 172-179. doi:10.1080/17453670710013645
[9] C. A. Busch, B. J. Shore, R. Bhandart, S. Gandapathy, S. J. MacDonald, R. B. Bourne, C. H. Rorabeck, R. W. McCalden, “Efficacy of Periarticular Multimodal Drug Injection in Total Knee Arthroplasty: A Randomised Trial,” The Journal of Bone & Joint Surgery, Vol. 88, No. 5, 2006, pp. 959-963. doi:10.2106/JBJS.E.00344
[10] H. B. J. Fisher, C. J. P. Simanski, C. Sharp, F. Bonnet, F. Camu, E. A. M. Neugebauer, N. Rawel, G. P. Joshi, S. A. Schug and H. Kehlet, “A Procedure-Specific Systematic Review and Consensus Recommendations for Postoperative Analgesia Following Total Knee Arthroplasty,” Anaesthesia, Vol. 63, No. 10, 2008, pp.1105-1123. doi:10.1111/j.1365-2044.2008.05565.x
[11] P. Vendittoli, P. Makinen, P. Drolet, M. Lavign, M. Fallaha, M. Guertin and F. B. Varin, “A Multimodal Analgesia Protocol for Total Knee Arthroplasty: A Randomised, Controlled Study,” The Journal of Bone & Joint Surgery, Vol. 88, No. 2, 2006, pp. 282-289. doi:10.2106/JBJS.E.00173
[12] Z. Dunsanka, K. Boysen, C. Christiansen, J. Christansen, S. Stephensen and B. Christensen, “A Comparison of Epidural Analgesia with Combined Continuous Femoral Sciatic Nerve Blocks after Total Knee Replacement,” Anaethesia and Analgesia, Vol. 102, No. 4, 2006, pp. 1240-1246. doi:10.1213/01.ane.0000198561.03742.50
[13] M. Kandasami, A. W. G. Kinninmonth and M. Sarungi, “Femoral Nerve Block for Total Knee Replacement—A Word of Caution,” Knee, Vol. 16, No. 2, pp. 98-100. doi:10.1016/j.knee.2008.10.007
[14] I. Smith, J. Hemelrijck, P. F. White, R. Shively, “Effects of Local Anesthesia on Recovery after Outpatient Arthroscopy,” Anaesthesia and Analgesia, Vol. 73, No. 5, 1991, pp. 536-539. doi:10.1213/00000539-199111000-00004
[15] N. H. Badner, R. B. Bourne, C. H. Rorabeck, S. J. MacDonald and J. A. Doyle, “Intra-Articular Injection of Bupivacaine in Knee Replacement Operations. Results of Use for Analgesia and for Preemptive Blockade,” The Journal of Bone & Joint Surgery, Vol. 78, No. 5, pp. 734-738.
[16] H. Ng, U. Nordstrom, K. Axelsson, A. D. Perniola, E. Gustav, L. Ryttberg, A. Gupta, “Efficacy of Intra-Articular Bupivocaine, Ropivacaine, or a Combination of Ropivacaine, Morphine, and Ketorolac on Postoperative Pain Releif after Ambulatory Arthroscoplic Knee Surgery: A Randomised Double Blind Study,” Regional Anesthesia and Pain Medicine, Vol. 31, No. 1, pp. 26-33.
[17] L. J. Andersen, T. Poulsen, B. Krog and T. Nielsen, “Postoperative Analgesia in Total Hip Arthroplasty: A Randomized Double-Blinded, Placebo-Controlled Sudy on Peroperative and Postoperative Ropivacaine, Ketorolac, and Adrenaline Wound Infiltration,” Acta Orthopaedica, Vol. 78, No. 2, pp. 187-192. doi:10.1080/17453670710013663
[18] P. R. Padala, E. Rouholamin and R. L. Mehta, “The Role of Drains and Tourniquets in Primary Total Knee Replacement—A Comparative Study of TKR Performed with Drains and Tourniquet versus No Drains and Adrenaline and Saline Infiltration,” Journal of Knee Surgery, Vol. 17, No. 1, pp. 24-27.
[19] D. M. R. Gibbs, T. P. Green, C. N. Esler, “The Local Infiltration of Analgesia Following Total Knee Replacement. A Review of the Current Literature,” The Journal of Bone & Joint Surgery Vol. 94, No. 9, 2012, pp. 1154-1159. doi:10.1302/0301-620X.94B9.28611

  
comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.