Comparision of Intraoperative Epidural Analgesia and Intraoperative Periarticular Injection on Pain Control After Total Knee Arthroplasty

The study interventions were epidural analgesia and periarticular injection. All patients will routinely receive a combined epidural spinal anesthesia. While the patients were in sitting position, appropriate site cleaning was performed and epidural catheter was inserted through the L3-L4 or L4-L5 intervertebral disc spaces using the 18G Tuohy needle. Next, differential spinal block was applied with the 27G Quincke spinal needle through the same disc space. 15mg 0.5% bupivacaine was administered into subarachnoid space. The operation was started when the spinal block reached the suitable level. During the operation, the patients were given oxygen through the Vent mask at a rate of 2 lt /min. In the Group I (Control group= epidural analgesia group): before wound closure, 3mg morphine sulfate + 7ml saline is administered through epidural catheter in all patients. In the Group II (periarticular injection group): a 100 ml coctail (0.5% bupivacaine (20 ml), 1 mg/ml of epinephrine (0.6 ml), 100 microgr/ ml of dexmedetomidine (1 ml), 8.4% magnesium sulfate (4ml), 10 mg/ml prednisolone (4 ml), 10 mg/ml morphine (0.5 ml) and 69.9 ml normal saline solution) will be prepared in two 50 ml syringes. This cocktail was administered periarticular injection before wound closure. The surgical technique and postoperative analgesia protocol were identical in both groups. The patients received patient-controlled epidural analgesia (PCEA) with 110 ml normal saline + 500 microg fentanyl + 200 mg 0.5% bupivacaine for postoperative pain management (bolus dose: 10 ml, lockout period: 20 minutes,without loading dose). All patients received epidural analgesia via the same type of PCA (Patient Controlled Analgesia) device. The primary outcome is a visual analog scale (VAS) pain score 72 hours after surgery and analgesic consumption. The total amount of analgesics, VAS scores and discharge time was recorded. .In all patients, the epidural catheters were withdrawn at the end of the postoperative 72th hour and 12 hours after the last dose of LMWH (Low Molecular Weight Heparin).