Postoperative Pain in Total Knee Arthoplasty Patients: The Effectiveness of Local Anaesthetic and Analgesic Agents

Abstract

Objective: To determine the efficacy of a periarticular injection of multimodal drugs, consisting of bupivacaine (a long acting local anesthetic), ketorolac ( Nonsteroidal anti-inflammatory) and epinephrine in providing effective postoperative pain relief following total knee arthroplasty. 

Methods: This randomized comparative study was conducted in the department of orthopaedics and Traumatology CMH Rawalpindi. Sixty patients undergoing unilateral total knee replacement were randomized for the study. All the patients received 30 mg ketorolac IV three times a day postoperatively. Thirty patients were given an intraoperative periarticular injection of analgesic and anaesthetic drugs, and thirty were. Visual analog scale was used to assess pain (range from 0 to 100mm in 10-mm increments) at zero, first and second postoperative day. Zero (0) mm indicated no pain whereas 100 mm indicated extreme pain. 

Results: Patients who had received the multimodal drug infiltration had significantly lower mean visual analog scores for post operative pain (p < 0.001) and had significantly reduced need for analgesia over the first forty-eight hours after the operation (p < 0.001). 

Conclusion: Periarticular infiltration of the knee during arthroplasty is an effective way of postoperative analgesia. It is simple, practical and safe. 

Key Words: Postoperative Pain, Total Knee Arthoplasty, local anaesthetic and analgesic agents