Efficacy Of Periarticular Mixed Drug Injection In Total Knee Arthroplasty

Background:Osteoathritis (OA) is a gradually progressive disease characterized as degeneration of articular cartilage, especially prone to knee and hip joint. Most knee osteoarthritis patients are beyond fifty years old. The main symptom of OA is pain, which is gradually aggravated, as the articular cartilage degrade and fall off, the bones around the articular surface begin to hyperplasia, and finally form the knee varus or valgus deformity. With the development of total knee arthroplasty (TKA), the TKA has become the primary choice of patients and doctors. However, due to the huge trauma of TKA itself, almost every patient suffers from severe pain after the surgery. Many pain-control methods are brought out, such as PCA or NSIADS, now these methods are mostly used simultaneously, which is defined as multimodal analgesia. But these drugs have serious adverse effect and still can not ease the pain enough. Recently, periarticular mixed drug injection in TKA is used in many TKA center in the world, which shows promising prospect.Purpose:To analyze the clinical efficacy of periarticular mixed drug injection in TKA as a part of multimodal analgesia.Methods: The clinical and pathological data of60patients diagnosed as knee joint osteoarthritis definitely in Henan provincial hospital of our department between December2010and September2011were collected, and subdivided into two group,30cases in experimental group and30cases in control group. Specific doctor collected the basic data of these patients, including heart rates, blood pressure, BMI, ROM, HSS score and rest pain VAS score. After careful preoperative examination, the subjects received TKA surgery, with the experimental group given periarticular mixed drug (including Morphine、epinephrine、betamethasone、ropivacaine) injection during the surgery and the control group not.Another specific doctor select the postoperative data, which includes postoperative4h,8h,12h,24h,48h rest pain VAS, postoperative24h,48h,72h exercise pain VAS, time-consuming of straight leg raising to30°, time-consuming of ROM to60°and90, and the ROM as well as the HSS two weeks after surgery.Results:Every patients were extract the drainage tube24h after the surgery. One patient in experimental group and two patients in control group got wound exudation, and after changing dressing, they all got cured. All the patients got suture removal two weeks after the surgery, except three Diabetes patients who got stitches15days after the surgery. There were no DVT and accidents of heart and brain vascular, all patients were discharged smoothly.The rest pain VAS of4h,8h,12h,24h and movement pain VAS of24h,48h in experimental group was significantly lower than in control group. The rest pain VAS after48h and the movement pain VAS after72h got no significant difference in both group. The consumption of analgesia drugs of experimental group was significantly lower than control group. The time-consuming of straight leg raising to30°and time-consuming of ROM to60°nd90°, in experimental group was significantly lower than in control group. The ROM as well as the HSS two weeks after surgery showed no significant variety.Conclusions: 1. The mixed drug periarticular injection in TKA dose not cause the increase of hemorrhage, nor the amount of drainage.2. Although accompanied with other analgesia measures like PCA and NSAIDs, the mixed drug periarticular injection in TKA still shows significant analgesia effect in early stage after the surgery, however it dose not show apparent analgesia effect during the late stage of surgery.3. In the early stage of function exercise, the mixed drug injection significantly accelerates the exercise process. In the late phase, this effect gradually does not obvious.4. The patients who received mixed drug injection need less analgesia drugs than those does not received, as a result the complication related with NSAIDs and Morphine apparently decrease, especially the respiratory inhibition and upper digestion ulcer.