Which analgesic mixture is appropriate for periarticular injection after total knee arthroplasty? Prospective, randomized, double-blind study

Verfasser / Beitragende:
[Tae Kim, Sang Park, Se Lim, Sang Seong, Sahnghoon Lee, Myung Lee]
Ort, Verlag, Jahr:
2015
Enthalten in:
Knee Surgery, Sports Traumatology, Arthroscopy, 23/3(2015-03-01), 838-845
Format:
Artikel (online)
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024 7 0 |a 10.1007/s00167-014-3366-x  |2 doi 
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245 0 0 |a Which analgesic mixture is appropriate for periarticular injection after total knee arthroplasty? Prospective, randomized, double-blind study  |h [Elektronische Daten]  |c [Tae Kim, Sang Park, Se Lim, Sang Seong, Sahnghoon Lee, Myung Lee] 
520 3 |a Purpose: Although the analgesic effect of periarticular injection after total knee arthroplasty (TKA) has been well documented, the gold standard for drug combination has not yet been established. In this study, the analgesic effects of six different drug combinations were compared. Methods: A total of 256 patients undergoing TKA for primary osteoarthritis were randomized into one of six groups: a control group (saline solution, epinephrine, and cefazolin, n=42), Group 1 (ropivacaine, n=43), Group 2 (ropivacaine+morphine, n=43), Group 3 (ropivacaine+ketorolac, n=42), Group 4 (ropivacaine+morphine+ketorolac, n=43), and Group 5 (ropivacaine+morphine+ketorolac+methylprednisolone, n=43). Pain level assessed by visual analogue scale (VAS) and opioid consumption were primary outcomes. The incidence of complications, range of motion (ROM), C-reactive protein (CRP) value, and the amount of post-operative blood drainage were also compared. Results: Patients in Groups 4 and 5 complained less pain than the control group for the first 12h after surgery, and the patients in the other groups showed less pain only during the initial 6h after surgery. Groups 4 and 5 also showed less opioid consumption than the control group during the 24h period after surgery. Patients in Group 5 showed no significant difference in VAS score and opioid consumption compared with Group 4, but they had lower CRP value and greater ROM than any other groups at post-operative day 2 and day 4. Conclusion: The combination of ropivacaine, morphine, and ketorolac showed a significantly stronger and sufficiently synergistic analgesic effect without adding methylprednisolone in periarticular injection after TKA. The clinical relevance of the study is that the combination of ropivacaine, morphine, and ketorolac can be a good option for periarticular injection following TKA in terms of synergistic analgesic effect and efficiency of drug combination. 
540 |a European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA), 2014 
690 7 |a Periarticular injection  |2 nationallicence 
690 7 |a Total knee arthroplasty  |2 nationallicence 
690 7 |a Drug combination  |2 nationallicence 
690 7 |a Analgesics  |2 nationallicence 
700 1 |a Kim  |D Tae  |u Department of Orthopaedic Surgery, Hallym University Hospital, 77, Sakju-ro, 200-704, Chuncheon-si, Gangwon-do, Korea  |4 aut 
700 1 |a Park  |D Sang  |u Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, 110-744, Seoul, Korea  |4 aut 
700 1 |a Lim  |D Se  |u Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, 110-744, Seoul, Korea  |4 aut 
700 1 |a Seong  |D Sang  |u Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, 110-744, Seoul, Korea  |4 aut 
700 1 |a Lee  |D Sahnghoon  |u Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, 110-744, Seoul, Korea  |4 aut 
700 1 |a Lee  |D Myung  |u Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, 110-744, Seoul, Korea  |4 aut 
773 0 |t Knee Surgery, Sports Traumatology, Arthroscopy  |d Springer Berlin Heidelberg  |g 23/3(2015-03-01), 838-845  |x 0942-2056  |q 23:3<838  |1 2015  |2 23  |o 167 
856 4 0 |u https://doi.org/10.1007/s00167-014-3366-x  |q text/html  |z Onlinezugriff via DOI 
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900 7 |a Metadata rights reserved  |b Springer special CC-BY-NC licence  |2 nationallicence 
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950 |B NATIONALLICENCE  |P 856  |E 40  |u https://doi.org/10.1007/s00167-014-3366-x  |q text/html  |z Onlinezugriff via DOI 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Kim  |D Tae  |u Department of Orthopaedic Surgery, Hallym University Hospital, 77, Sakju-ro, 200-704, Chuncheon-si, Gangwon-do, Korea  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Park  |D Sang  |u Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, 110-744, Seoul, Korea  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Lim  |D Se  |u Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, 110-744, Seoul, Korea  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Seong  |D Sang  |u Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, 110-744, Seoul, Korea  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Lee  |D Sahnghoon  |u Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, 110-744, Seoul, Korea  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Lee  |D Myung  |u Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, 110-744, Seoul, Korea  |4 aut 
950 |B NATIONALLICENCE  |P 773  |E 0-  |t Knee Surgery, Sports Traumatology, Arthroscopy  |d Springer Berlin Heidelberg  |g 23/3(2015-03-01), 838-845  |x 0942-2056  |q 23:3<838  |1 2015  |2 23  |o 167