Efficacy Of Periarticular Multimodal Drug Injection In Total Knee Arthroplasty

purpose: Postoperative analgesia with the use of parenteral opioids or epidural analgesia can be associated withtroublesome side effects.Good perioperative analgesia facilitatesrehabilitation,improves patient satisfaction,and mayreduce the hospital stay.We investigated the analgesic effect of locally injected drugs around a total knee prosthesis.Methods: Sixty-four patients undergoing total knee arthroplasty were randomized either to receive a periarticular in-traoperative injection containing ropivacaine,ketorolac,epimorphine,and epinephrine or to receive no injection.Theperioperative analgesic regimen was standardized.All patients in both groups received patient-controlled analgesiafor twenty-four hours after the surgery,and this was followed by standard analgesia.Visual analog scores for pain,during activity and at rest,and for patient satisfaction were recorded preoperatively and postoperatively and at thesix-week follow-up examination.The consumption of patient-controlled analgesia at specific postoperative time-pointsand the overall analgesic requirement were measured.Results: The patients who had received the injection used significantly lesspatient-controlled analgesia at six hours,at twelve hours,and over the first twenty-four hours after the surgery.In addition,they had higher visual analogscores for patient satisfaction and lower visual analog scores for pain during activity in the post-anesthetic-care unitand four hours after the operation.No cardiac or central nervous system toxicity was observed.Conclusions: Intraoperative periarticular injection with multimodal drugs cansignificantly reduce the requirements forpatient-controlled analgesia and improve patientsatisfaction,with no apparent risks,following total knee arthroplasty.