Öz
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.
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