Effect Of Subperiosteal "Cocktail" Injection On Early Postoperative Pain And Blood Loss In Total Knee Arthroplasty

Background: Early postoperative pain and blood loss in total knee arthroplasty(TKA)is still a hot topic in clinical research.A lot of studies showed that periarticular “cocktail” injection can effectively reduce pain and blood loss after TKA,however,there was no unified standard about the“cocktail” recipe and injection site.The purpose of this study was to investigate whether subperiosteal “cocktail” injection was more effective than periarticular “cocktail” injection in reducing early postoperative pain and blood loss in TKA.Methods: Patients were divided into two groups according to the different “cocktail” injection sites.A multi-point,local injection of the“cocktail” was performed before the osteotomy,in group 1,“cocktail” were injected into the muscles,tendons,and the synovial tissue of suprapatellar bursa and subpatellar bursa around the knee joint before osteotomy,in group 2,“cocktail” injection was performed under the periosteum of the distal femur and proximal tibia.Our primary outcomes were visual analogue scale(VAS)and hemoglobin(Hb),and the secondary outcomes were wound healing,infection,deep vein thrombosis(DVT),operation timeand hospitalization.Results: At the first operative day,the mean(standard deviation)VAS score in the resting state was lower in group 2 compared with group1(0.98±0.27 in group 1 and 0.86±0.60 in group 2,p<0.05).In the state of flexion and extension,the mean(standard deviation)VAS was 1.61±0.66 in group 1 and 1.10±0.57 in group 2(p<0.05).The mean(standard deviation)blood loss was higher in group 1 than group 2 at the first postoperative day(440.19(167.68)ml in group 1 and 333.67(205.99)ml in group 2,p<0.05).At the third day after surgery,the mean(standard deviation)blood loss was 686.44(140.29)ml in group 1 and 609.19(260.30)ml in group 2,and there was significant difference between this two groups(P<0.05).Conclusions: Subperiosteal “cocktail” injection would better reduce the early postoperative pain and blood loss compared with the periarticular“cocktail” injection.This method does not increase the incidence of postoperative wound infection and DVT,which may be a better way to improve the prognosis of TKA.