Patient function & pain control after total knee replacement: Is it improved by use of peri-articular or intra-articular infiltration ?
Comparison of postoperative pain control in patients receiving total knee replacement, using either periarticular or intraarticular local infiltration analgesia.
Fremantle Hospital
142 participants
Oct 5, 2009
Interventional
Conditions
Summary
Total knee replacement (TKR) is a common operation for knee arthritis. Effective pain control is important in post-operative recovery and rehabilitation. Recent studies have shown that injections of a mixture of medications into the tissues around the knee at the time of surgery can decrease the amount of pain experienced after surgery, leading to improved rehabilitation and a shorter hospital stay. We would like to determine if pain is better controlled with injections into the tissues around the knee joint (periarticular), compared to injections into the joint itself (intraarticular) at the time of total knee replacement surgery.
Eligibility
Inclusion Criteria1
- adult patients waitlisted for primary total knee replacement for osteoarthritis.
Exclusion Criteria1
- allergy or intolerance to study drugs, known inability to receive spinal anaesthesia, and planned bilateral knee surgery.
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Interventions
One hundred and forty two consecutive patients undergoing total knee arthroplasty were enrolled. Patients were divided into 2 groups, a periarticular infiltration group (Group A) and an intraarticular injection group (Group B). Both groups received the same infiltrate – a combination of 30mg ketorolac, 500mcg of adrenaline, and 300mg of ropivacaine, and normal saline. In Group A patients, the 150mL was infiltrated after implantation of the prosthesis, prior to insertion of the polyethylene liner. Of this, 50mL was infiltrated into the posterior capsule and intercondylar area; 50mL was infiltrated into the anterior capsule, the collateral ligaments and along the femur and tibia; and the remaining 50mL was infiltrated into subcutaneous tissue following closure of the capsule. Group B patients had all of the 150ml injected intraarticularly after closure of the wound.
Locations(1)
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ACTRN12615000488505