Effects Of Cocktail Therapy On Knee Skin Temperature After Total Knee Arthroplasty

Objective:Severe post-operative pain is one of the main problems after total knee arthroplasty.The peri-articular multimodal cocktail injection is currently commonly used to treat postoperative pain after total knee arthroplasty(TKA).To evaluate the effects of the cocktail therapy on pain control,knee skin temperature and ROM after primary total knee arthroplasty(TKA)and aim to establish the pattern of postoperative knee skin temperature which can be used to improve the diagnostic rate of early prosthesis infection around the knee arthroplasty.Methods:From Oct 2015 to Jun 2016,78 patients who underwent TKA were selected from department of Joint Surgery.This is a prospective,single-center,randomized controlled trial involving 78 patients scheduled for unilateral TKA.Patients of the intervention group were injected with cocktail drugs(0.75%Ropivacaine Hydrochloride 150mg + 0.1%Epinephrine 0.1 mg + 3%Ketorolac Tromethamine 30mg)25ml respectively when the exposure of surgical field and before the closure of joint capsule.The control group got no intervention in the local area.Additional analgesic methods in perioperative period were used on both groups.Postoperative assessment was performed with all attending personnel and patients blinded to group assignment.Visual analogue scales(VAS)at 4h?8h?12h when rest and at 24h?48h?72h when move,knee skin temperature at pre-operation?post-1d?2d?3d?5d?1w?2w?1m?3m,range of motion(ROM)and supplemental analgesic drugs were recorded.Results:Patients in the intervention group had lower VAS for pain at rest and activity after TKA compared with the control group(P<0.05).After the surgery,the skin temperature of operated and contralateral knees both rose up to a higher level compared to pre-operation,especially on the operated sides.The skin temperature remained elevated up to 3 months.The mean value of the difference temperature between the two knees had a peak at 5-7 days.The mean skin temperature of intervention group was lower than control groups' at first 3 days after TKA.The ROM of intervention group is higher than the ROM of control group(P<0.05).Conclusions:The effects of cocktail therapy combined with multi-modal analgesia in patients after TKA on pain and high skin temperature are satisfactory,and the patients'joint function recovered well with cocktail therapy.There is no need to worry about the normal elevation on skin temperature unless sustained increases in the postoperative knee skin temperature or other features of pattern.If that happens,the patient should do further examination to rule out infection.