The Efficacy Of Operative Field Analgesic Mixture Injection In Total Knee Arthroplasty

Background:Osteoarthritis(OA) is a common orthopaedic disease characterized as degeneration of articular cartilage,whichcan affect many joints,especially in the keen joint.The main symptom of OA is pain,which is gradually aggravated,the quality of their life becomes lower.Total knee arthroplasty(TKA) has become the effective method for the treatment of knee joint pain.TKA has greatly improved the quality of life in the patients with knee joint degeneration. However, TKA need a wide range of tissue release, a large number of bone cutting and postoperative functional exercise.Therefore some acute postoperative pain appear, which result in poor early functional recovery and affect the operation effect. There are a lot of analgesic models for the TKA.Not only can the periarticular mixed drug injection make the drug directly act on the local,but also can avoid the early adverse reactions for using opioids or NSIADS in postoperative intravenous system, which shows promising prospect.Objective :To evaluate the efficacy and safety of intra-articular cocktail analgesic mixture injection after total knee arthroplasty.Methods:60 patients with osteoartritis who were scheduled to undergo unilateral TKA were randomly divided two groups: injection group(n =30),where patients received intra-articular analgesic mixture injection containing morphine,ropivacaine and triamcinolone acetonide,and control group(n =30).All the patients took Eloricoxib(Non-steroidal anti-inflammatory analgesic drugs, NSAIDs)orally before and after TKA for 2 weeks until the patients discharged from hospital. Used of opioid drug(Dezocine) when necessary. The numerical rating scale scores( NRS),the knee joint range of motion(ROM),the time of ability to perform an active straight leg raise,the side effects, complications and the keen society score(KSS)after 6 months were recorded.Results: The postoperative motional NRS scores were lower in injection group than in control group at 4h to 7d(P<0.05).The postoperative rest NRS scores a were lower in injection group than in control group at 4h to 3d(P<0.05).The knee joint range of motion were better in injection group than in control group at 4h to 7d(P<0.05).The time of ability to perform an active straight leg raise was shorter in injection group than in control group(P<0.05).In injection group the use of opioids was less and the side effects were lower(P<0.05).No infection was found in these 60 patients(P>0.05).There were no significant differences in The keen society score between the two groups at the 6th month(P>0.05).Conclusion: Intra-articular cocktail analgesic mixture injection not only improves the short-term pain control and the knee joint range of motion, but also reduces narcotic consumption without apparent risks following TKA.