Single intra-articular analgesic cocktail for immediate postoperative pain management following total knee replacement in a teaching hospital.

Abstract

Background: Inadequate pain relief after Total Knee

Replacement (TKR) could hinder early ambulation

with increased morbidity and mortality. Several

analgesic models had been deployed with varying

outcomes with recent evidence in favor of addition

of peri or intra-articular infiltration of analgesic

cocktail as part of the multimodal analgesia.

Objective: We prospectively compared the

effectiveness of a single intra-articular analgesic

cocktail with epidural analgesia on the immediate

postoperative pain management in TKR patients.

Method: Following institutional ethical clearance and

consent from patients, 20mls of 0.5% plain

bupivacaine, 10mg of morphine, and 1mg of

Adrenaline constituted into 50ml was given intra

articularly (lA ) to first 7 of the 22 patients, ASA II,

aged 47-82 years, who had TKR. 15 patients had

Epidural (Ep ) top ups of 6ml of 0.1% plain bupivacaine.

Pain was assessed. Opioid use, complications and length

of hospital stay were documented. Data was analyzed.

Non parametric test was used to test for significance

with p value < 0.05.

Results: The mean Numerical Rating Scale (NRS)

values IA vs Ep. were 3.1 ± 0.37, 3.2 ± 0.69, 3.4 ± 0.53,

3.4 ± 0.53 at 4hrs, 12hrs, 24hrs and 48hrs vs 4.2 ± 0.47,

4.8 ±0.58, 3.7 ± 0.49 and 3.5 ± 0.51 with p < .05 at 4hrs

and at 12hrs. There was no significant difference in the

opioid use with the percentage having opioid related

complications comparable in both groups; the length of

hospital stay was, however, not significant.

Conclusion: Single intra-articular analgesia, as part

of the multimodal analgesia, was effective in the

immediate postoperative pain management in TKR

patients, where early ambulation and rehabilitations

were key to successful outcome.