Background: Postoperative analgesia with the use of parenteral
opioids or epidural analgesia can be associated with troublesome side effects.
Good perioperative analgesia facilitates rehabilitation, improves patient
satisfaction, and may reduce the hospital stay. We investigated the analgesic
effect of locally injected drugs around a total knee prosthesis.
Methods: Sixty-four patients undergoing total knee arthroplasty were
randomized either to receive a periarticular intraoperative injection
containing ropivacaine, ketorolac, epimorphine, and epinephrine or to receive
no injection. The perioperative analgesic regimen was standardized. All
patients in both groups received patient-controlled analgesia for twenty-four
hours after the surgery, and this was followed by standard analgesia. Visual
analog scores for pain, during activity and at rest, and for patient
satisfaction were recorded preoperatively and postoperatively and at the
six-week follow-up examination. The consumption of patient-controlled
analgesia at specific postoperative time-points and the overall analgesic
requirement were measured.
Results: The patients who had received the injection used
significantly less patient-controlled analgesia at six hours, at twelve hours,
and over the first twenty-four hours after the surgery. In addition, they had
higher visual analog scores for patient satisfaction and lower visual analog
scores for pain during activity in the post-anesthetic-care unit and four
hours after the operation. No cardiac or central nervous system toxicity was
Conclusions: Intraoperative periarticular injection with multimodal
drugs can significantly reduce the requirements for patient-controlled
analgesia and improve patient satisfaction, with no apparent risks, following
total knee arthroplasty.
Level of Evidence: Therapeutic Level I. See Instructions
to Authors for a complete description of levels of evidence.