1
|
Luo Z, Zeng W, Chen X, Xiao Q, Chen A, Chen J, Wang H, Zhou Z. Cocktail of Ropivacaine, Morphine, and Diprospan Reduces Pain and Prolongs Analgesic Effects after Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. Int J Clin Pract 2024; 2024:3697846. [PMID: 38450292 PMCID: PMC10917473 DOI: 10.1155/2024/3697846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/26/2023] [Accepted: 01/17/2024] [Indexed: 03/08/2024] Open
Abstract
Background Local infiltration analgesia (LIA) provides postoperative analgesia for total knee arthroplasty (TKA). The purpose of this study was to evaluate the analgesic effect of a cocktail of ropivacaine, morphine, and Diprospan for TKA. Methods A total of 100 patients from September 2018 to February 2019 were randomized into 2 groups. Group A (control group, 50 patients) received LIA of ropivacaine alone (80 ml, 0.25% ropivacaine). Group B (LIA group, 50 patients) received an LIA cocktail of ropivacaine, morphine, and Diprospan (80 ml, 0.25% ropivacaine, 0.125 mg/ml morphine, and 62.5 μg/ml compound betamethasone). The primary outcomes were the levels of inflammatory markers C-reactive protein (CRP) and interleukin-6 (IL-6), pain visual analog scale (VAS) scores, opioid consumption, range of motion (ROM), functional tests, and sleeping quality. The secondary outcomes were adverse events, satisfaction rates, HSS scores, and SF-12 scores. The longest follow-up was 2 years. Results The two groups showed no differences in terms of characteristics (P > 0.05). Group B had lower resting VAS pain scores (1.54 ± 0.60, 95% CI = 1.37 to 1.70 vs. 2.00 ± 0.63, 95% CI = 2.05 to 2.34) and active VAS pain scores (2.64 ± 0.62, 95% CI = 2.46 to 2.81 vs. 3.16 ± 0.75, 95% CI = 2.95 to 3.36) within 48 h postoperatively than Group A (P < 0.001), while none of the pain differences exceeded the minimal clinically important difference (MCID). Group B had significantly lower CRP levels (59.49 ± 13.01, 95% CI = 55.88 to 63.09 vs. 65.95 ± 14.41, 95% CI = 61.95 to 69.94) and IL-6 levels (44.11 ± 13.67, 95% CI = 40.32 to 47.89 vs. 60.72 ± 15.49, 95% CI = 56.42 to 65.01), lower opioid consumption (7.60 ± 11.10, 95% CI = 4.52 to 10.67 vs. 13.80 ± 14.68, 95% CI = 9.73 to 17.86), better ROM (110.20 ± 10.46, 95% CI = 107.30 to 113.09 vs. 105.30 ± 10.02, 95% CI = 102.52 to 108.07), better sleep quality (3.40 ± 1.03, 95% CI = 3.11 to 3.68 vs. 4.20 ± 1.06, 95% CI = 3.90 to 4.49), and higher satisfaction rates than Group A within 48 h postoperatively (P < 0.05). Adverse events, HSS scores, and SF-12 scores were not significantly different within 2 years postoperatively. Conclusions A cocktail of ropivacaine, morphine, and Diprospan prolongs the analgesic effect up to 48 h postoperatively. Although the small statistical benefit may not result in MCID, the LIA cocktail still reduces opioid consumption, results in better sleeping quality and faster rehabilitation, and does not increase adverse events. Therefore, cocktails of ropivacaine, morphine, and Diprospan have good application value for pain control in TKA. This trial is registered with ChiCTR1800018372.
Collapse
Affiliation(s)
- Zhenyu Luo
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Weinan Zeng
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Xi Chen
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Qiang Xiao
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Anjing Chen
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Jiali Chen
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
- Department of Orthopedics, West China Hospital, West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Haoyang Wang
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Zongke Zhou
- Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
| |
Collapse
|
2
|
Bugada D, Compagnone C, Bettinelli S, Grimaldi S, DE Gregori M, Muscoli C, Berretta R, Cobianchi L, Peloso A, Lorini L, Lavand'homme P, Allegri M. Prolonged continuous wound infusion of local anesthetic and steroid after major abdominal surgery to reduce opioid consumption: a randomized, double-blind trial. Minerva Anestesiol 2023; 89:625-635. [PMID: 37194239 DOI: 10.23736/s0375-9393.23.16547-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Continuous wound infusion (CWI) is effective for post-operative pain management, but the effect of prolonged infusions and the use of steroids in the infused mixture have never been addressed. We investigate the effect of prolonged CWI with ropivacaine 0.2% (R) over seven days and methylprednisolone (Mp) 1 mg/kg infused in the wound in the first 24 hours. METHODS This is a randomized, double blind, phase III trial (RCT) in major abdominal surgery with laparotomy. After a 24-hours pre-peritoneal CWI of R-Mp, patients were randomized to receive either R-Mp or placebo for the next 24 hours. Then, patient-controlled CWI with only ropivacaine 0.2% or placebo (according to the randomization group) was planned between 48 hours and seven days after surgery. Morphine equivalents at seven days were analyzed, together with any catheter- or drug-related side effect and PPSP at 3 months. RESULTS We enrolled 120 patients (63 in the CWI group, 57 in the placebo group). Prolonged CWI did not reduce opioid consumption in the first seven postoperative days (P=0.08). CWI was associated with reduced consumption of non-opioid analgesics (P=0.03). Most of the patients continued to require bolus in the surgical wound beyond 48 hours. PPSP prevalence was not different between groups. CONCLUSIONS Prolonged infusion with R-Mp is safe and effective but did not reduce opioid consumption in the seven days after surgery or PPSP prevalence.
Collapse
Affiliation(s)
- Dario Bugada
- Department of Emergency and Critical Care Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy -
| | - Christian Compagnone
- Service of Anesthesia, Intensive Care and Pain Therapy, University Hospital of Parma, Parma, Italy
| | - Silvia Bettinelli
- Department of Emergency and Critical Care Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefania Grimaldi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Manuela DE Gregori
- Clinical and Experimental Pharmacokinetics Unit, San Matteo IRCCS Foundation, Pavia, Italy
| | - Carolina Muscoli
- Institute of Research for Food Safety & Health (IRC-FSH), Department of Health Science, Magna Graecia University, Catanzaro, Italy
| | - Roberto Berretta
- Department of Gynecology and Obstetrics, University of Parma, Parma, Italy
| | - Lorenzo Cobianchi
- Department of General Surgery, San Matteo IRCCS Foundation, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Peloso
- Department of General Surgery and Transplantation, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Luca Lorini
- Department of Emergency and Critical Care Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Massimo Allegri
- Pain Therapy Service, Policlinico di Monza Hospital, Monza, Monza-Brianza, Italy
- Centre Lemanique d'antalgie et neuromodulation, Ensemble Hospitalier de la Côte, Morges, Switzerland
| |
Collapse
|
3
|
Padgett AM, Kapoor S, Rhodes LN, Keen K, Cao X, Locke LL, Warner WC, Sawyer JR, Sheffer BW, Spence DD, Kelly DM. Perioperative multimodal analgesic injection for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion surgery. Spine Deform 2023; 11:977-984. [PMID: 37022606 DOI: 10.1007/s43390-023-00670-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/18/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE This retrospective cohort study compared postoperative as-needed (PRN) opioid consumption pre and postimplementation of a perioperative multimodal analgesic injection composed of ropivacaine, epinephrine, ketorolac, and morphine in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Secondary outcomes include pain score measurements, time to ambulation, length of stay, blood loss, 90-day complication rate, operating room time, nonopioid medication usage, and total inpatient medication cost before and after the initiation of this practice. METHODS Consecutive patients weighing ≥ 20 kg who underwent PSF for a primary diagnosis of AIS between January 2017 and December 2020 were included. Data from 2018 were excluded to account for standardization of the practice. Patients treated in 2017 only received PCA. Patients treated in 2019 and 2020 only received the injection. Excluded were patients who had any diagnoses other than AIS, allergies to any of the experimental medications, or who were nonambulatory. Data were analyzed utilizing the two-sample t-test or Chi-squared test as appropriate. RESULTS Results of this study show that compared with 47 patients treated postoperatively with patient-controlled analgesia (PCA), 55 patients treated with a multimodal perioperative injection have significantly less consumption of PRN morphine equivalents (0.3 mEq/kg vs. 0.5 mEq/kg; p = 0.02). Furthermore, patients treated with a perioperative injection have significantly higher rates of ambulation on postoperative day 1 compared with those treated with PCA (70.9 vs. 40.4%; p = 0.0023). CONCLUSION Administration of a perioperative injection is effective and should be considered in the perioperative protocol in patients undergoing PSF for AIS. LEVEL OF EVIDENCE Therapeutic Level III.
Collapse
Affiliation(s)
- Anthony M Padgett
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA
| | - Seerat Kapoor
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, USA
- Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Leslie N Rhodes
- Le Bonheur Children's Hospital, Memphis, TN, USA
- University of Tennessee Health Science Center, College of Nursing, Memphis, TN, USA
| | - Katie Keen
- Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Xueyuan Cao
- University of Tennessee Health Science Center, College of Nursing, Memphis, TN, USA
| | | | - William C Warner
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - Jeffrey R Sawyer
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - Benjamin W Sheffer
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - David D Spence
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - Derek M Kelly
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA.
- Department of Biomedical Engineering and Orthopaedic Surgery, University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN, 38104, USA.
| |
Collapse
|
4
|
Küçükalp A, Özdemir B. Pain management following simultaneous bilateral total knee arthroplasty: genicular nerve blockade versus periarticular injection. Acta Orthop Belg 2023; 89:307-315. [PMID: 37924548 DOI: 10.52628/89.2.11542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The aim of the present study was to investigate whether the analgesic solution prepared for periarticular injection (PAI) could be utilized as a genicular nerve blockade (GNB) agent in bilateral knee arthroplasty, and to assess the pain control efficacy of this approach in comparison with PAI. This was a retrospective cohort in which patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were evaluated. Thirty patients were enrolled. The standard PAI was used for one knee, while the PAI solution was applied in the form of GNB to the other. Visual Analog Scale (VAS) pain scores were measured and recorded separately for each knee, at rest (static) and during exercise (dynamic). Active range of joint motion (JRM) for both knee joints was measured preoperatively, at postoperatively. Compared to the PAI group, the GNB group had lower VAS scores at 2 and 8 hours (p = 0.030 and p < 0.001, respectively). The GNB group also had lower dynamic VAS scores at 2, 8, and 24 hours (p = 0.009, p <0.001 and p<0.001, respectively). Static and dynamic VAS measurements did not demonstrate any differences between groups (GNB vs. PAI) at 48 hours and 30 days (p>0.05). When the reduction in VAS scores was assessed, we found that the decrease in both scores was significantly greater in the PAI group compared to the GNB group (p<0.001, for both). There were no significant differences between the groups with regard to drainage volume, complications and JRM (p>0.05). GNB was found to be more effective for pain control throughout the first postoperative day in patients who underwent simultaneous bilateral TKA.
Collapse
|
5
|
Chan PK, Chan TCW, Mak CYH, Chan THM, Chan SHW, Wong SSC, Fu H, Cheung A, Chan VWK, Cheung MH, Cheung CW, Chiu KY. Pain Relief After Total Knee Arthroplasty with Intravenous and Periarticular Corticosteroid: A Randomized Controlled Trial. J Bone Joint Surg Am 2023; Publish Ahead of Print:00004623-990000000-00809. [PMID: 37220180 DOI: 10.2106/jbjs.22.01218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a cost-effective procedure, but it is also associated with substantial postoperative pain. The present study aimed to compare pain relief and functional recovery after TKA among groups that received intravenous corticosteroids, periarticular corticosteroids, or a combination of both. METHODS This randomized, double-blinded clinical trial in a local institution in Hong Kong recruited 178 patients who underwent primary unilateral TKA. Six of these patients were excluded because of changes in surgical technique; 4, because of their hepatitis B status; 2, because of a history of peptic ulcer; and 2, because they declined to participate in the study. Patients were randomized 1:1:1:1 to receive placebo (P), intravenous corticosteroids (IVS), periarticular corticosteroids (PAS), or a combination of intravenous and periarticular corticosteroids (IVSPAS). RESULTS The pain scores at rest were significantly lower in the IVSPAS group than in the P group over the first 48 hours (p = 0.034) and 72 hours (p = 0.043) postoperatively. The pain scores during movement were also significantly lower in the IVS and IVSPAS groups than in the P group over the first 24, 48, and 72 hours (p ≤ 0.023 for all). The flexion range of the operatively treated knee was significantly better in the IVSPAS group than in the P group on postoperative day 3 (p = 0.027). Quadriceps power was also greater in the IVSPAS group than in the P group on postoperative days 2 (p = 0.005) and 3 (p = 0.007). Patients in the IVSPAS group were able to walk significantly further than patients in the P group in the first 3 postoperative days (p ≤ 0.003). Patients in the IVSPAS group also had a higher score on the Elderly Mobility Scale than those in the P group (p = 0.036). CONCLUSIONS IVS and IVSPAS yielded similar pain relief, but IVSPAS yielded a larger number of rehabilitation parameters that were significantly better than those in the P group. This study provides new insights into pain management and postoperative rehabilitation following TKA. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- P K Chan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR
| | - T C W Chan
- Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital, Hong Kong SAR
| | - C Y H Mak
- Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital, Hong Kong SAR
| | - T H M Chan
- Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital, Hong Kong SAR
| | - S H W Chan
- Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital, Hong Kong SAR
| | - S S C Wong
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong SAR
| | - H Fu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR
| | - A Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR
| | - V W K Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR
| | - M H Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR
| | - C W Cheung
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong SAR
| | - K Y Chiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR
| |
Collapse
|
6
|
Ebihara T, Hamada T, Nakamura K, Inokuchi A, Izumi T, Imamura R, Inoue T, Inoue H, Kuroki Y, Arizono T. Efficacy of Corticosteroid Addition to a Periarticular Cocktail Injection to Counteract Nausea and Vomiting After Total Knee Arthroplasty. Cureus 2023; 15:e33874. [PMID: 36819319 PMCID: PMC9934463 DOI: 10.7759/cureus.33874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intraoperative periarticular injection of a "cocktail" of drugs is undertaken commonly in total knee arthroplasty (TKA). The addition of a corticosteroid to the periarticular injection is believed to offer greater pain relief because of its local anti-inflammatory effects, but the prevalence of postoperative nausea and vomiting (PONV) is not known. This retrospective observational study aimed to elucidate the relationship between corticosteroid addition to a periarticular cocktail injection (PCI) and PONV. MATERIALS AND METHODS Fifty-nine patients who underwent unilateral TKA for primary osteoarthritis were divided into two groups: corticosteroid and non-corticosteroid. The former had triamcinolone acetonide (40 mg) added to the same PCI. The primary outcome was the prevalence of nausea and vomiting within 48 hours following TKA. RESULTS There was no significant difference between the two groups in terms of patient demographics. The overall prevalence of PONV was 16.9%. Fewer patients in the corticosteroid group complained of PONV than in the non-corticosteroid group (6.4% vs. 58.3%; p = 0.012). CONCLUSIONS The addition of a corticosteroid to a PCI suppressed PONV. Our results suggested that cocktail injections may have local and systemic effects.
Collapse
Affiliation(s)
- Toshihiro Ebihara
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Takahiro Hamada
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Kimitaka Nakamura
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Akihiko Inokuchi
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Teiyu Izumi
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Ryuta Imamura
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Takahiro Inoue
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Hayato Inoue
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Yosuke Kuroki
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| | - Takeshi Arizono
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN
| |
Collapse
|
7
|
Salwan A, Pisulkar GL, Taywade S, Awasthi AA, Saoji A, Jadawala VH, Shah P, Deshpande SV. A Review on the Efficacy of Extraosseous Local Infiltration of Multimodal Drug Cocktail for Pain Management After Total Knee or Hip Arthroplasty. Cureus 2022; 14:e30451. [DOI: 10.7759/cureus.30451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
|
8
|
Pain Management of Hallux Valgus Surgery Is Achieved by Cocktail Therapy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1084815. [PMID: 36091582 PMCID: PMC9463003 DOI: 10.1155/2022/1084815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022]
Abstract
Background. Hallux valgus is a relatively common forefoot disease in clinical practice. The aim of our study was to assess the role of local cocktail drugs and postoperative pain after hallux valgus surgery. Methods. A retrospective case-control study was conducted to analyze 75 moderate to severe hallux valgus patients from June 1, 2018 to December 1, 2019. All patients were divided into cocktail and control groups according to whether the cocktail therapy was used or not after the operation. The anesthesiologist did not provide analgesic treatment other than nerve block anesthesia and intravenous anesthesia, such as analgesic pumps. The operative region of the cocktail group received a mixture of 10 ml of 0.75% ropivacaine, 10 ml of flurbiprofen axetil injection, and 1 ml of compound betamethasone injection, whereas the control group received nothing in the surgical spot. We recorded patients’ VAS scores preoperatively and at 6, 24 hours postoperatively; the length of hospital stay and the number of hospitalization expenses; the scores of Kolcaba comfort level; and the scores of Pittsburgh sleep quality. Result. There was no significant difference in age or sex between the two groups. The VAS scores at 6 and 24 hours postoperatively were significantly lower in the cocktail group. The average length of hospital stay was 8.24 days in the control group and 3.73 days in the cocktail group. The average total hospitalization cost of the control group was ¥28285.16, and that of the cocktail group was ¥22366.31. In expenses of total hospitalization costs, the cocktail group was lower than the control group. Kolcaba’s comfort various scores and the total score of the cocktail group were higher than the control group. The total score of PSQI and all dimensions in the experimental group were lower than those in the control group. Conclusion. We found a significant difference in the results of postoperative pain management except for age, sex, and hospitalization expenses. After hallux valgus surgery, inject cocktail drugs around the first metatarsophalangeal joint did reduce postoperative pain level. Level of Evidence. Level III, case-control study.
Collapse
|
9
|
De Lamo-Rovira J, López-Caba F, Giménez-Giménez J, Szczepan W, Quijada-Rodriguez JL, Solera-Martínez M. Periarticular injection and hamstring block versus placebo for pain control in anterior cruciate ligament reconstruction: A randomized controlled trial. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03357-1. [PMID: 35984519 DOI: 10.1007/s00590-022-03357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To study the effectiveness of periarticular infiltration (PI), including the proximal donor site vs. placebo in anterior cruciate ligament (ACL) reconstruction. METHOD A total of 44 patients were randomized in two groups assigned to receive PI or placebo. The perioperative protocol was the same for both groups. The principal outcome was pain measured at 8 and 24 h by a visual analog scale (VAS). The pain was registered in the knee and the proximal donor site. Pain scores were also assessed to determine whether the VAS improvement would reach the threshold values reported for the minimal clinically significant difference. The secondary outcome was the need for opioid rescue medication. RESULTS Patients receiving PI exhibited lower pain values in the knee at 8 h (mean PI 35.00 ± 5.76 vs. placebo 60.23 ± 4.52 p = 0.01) and at 24 h (mean PI 37.23 ± 5.62 vs. placebo 55.55 ± 3.41 p = 0.008). These results were above the threshold for clinical significance. No improvements were found in proximal donor site pain and consumption of opioid rescue medication. Complications were comparable between the two groups. CONCLUSION PI significantly reduced pain in the knee vs. placebo after ACL reconstruction with hamstring autograft at 8 and 24 h after surgery. The instillation of part of the mixture in the proximal hamstring stump did not result in any improvement LEVEL OF EVIDENCE I: Level I, randomized controlled trial.
Collapse
Affiliation(s)
- Joaquín De Lamo-Rovira
- Department of Orthopaedics, Virgen de La Luz Hospital, Hermandad Donantes de Sangre street, 16004, Cuenca, Spain.
| | - Francisco López-Caba
- Department of Orthopaedics, Virgen de La Luz Hospital, Hermandad Donantes de Sangre street, 16004, Cuenca, Spain
| | - Juan Giménez-Giménez
- Department of Orthopaedics, Virgen de La Luz Hospital, Hermandad Donantes de Sangre street, 16004, Cuenca, Spain
| | - Witold Szczepan
- Department of Orthopaedics, Virgen de La Luz Hospital, Hermandad Donantes de Sangre street, 16004, Cuenca, Spain
| | - Jose Luis Quijada-Rodriguez
- Department of Orthopaedics, Virgen de La Luz Hospital, Hermandad Donantes de Sangre street, 16004, Cuenca, Spain
| | - Montserrat Solera-Martínez
- Health and Social Research Center and Faculty of Nursing, Universidad de Castilla-La Mancha, Edificio Melchor Cano. Santa Teresa Jornet S/N, Cuenca, Spain
| |
Collapse
|
10
|
Chaturvedi R, Tram J, Chakravarthy K. Reducing opioid usage in total knee arthroplasty postoperative pain management: a literature review and future directions. Pain Manag 2021; 12:105-116. [PMID: 34551582 DOI: 10.2217/pmt-2020-0107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Total knee arthroplasty (TKA) is a common orthopedic surgery performed with a projected 3.5 million procedures to be done by 2030. Current postoperative pain management for TKA is insufficient, as it results in extensive opioid consumption and functional decline postoperatively. This study identifies the best practices for postoperative TKA pain management through a literature review of the last three years. Studies utilizing interventional techniques (local infiltration analgesia, nerve blocks) and pharmacologic options were reviewed on PubMed, Embase, Ovid Medline and Scopus. Primary outcomes analyzed were the effect of different analgesic approaches on pain reduction, opioid use reduction and improvements in functional mobility or quadriceps strength postoperatively. Additionally, this paper explores the use of cooled radiofrequency ablation, a minimally invasive therapy, for preoperative and postoperative TKA pain management.
Collapse
Affiliation(s)
- Rahul Chaturvedi
- Department of Anesthesiology, Division of Pain Medicine, University of California San Diego, 9400 Campus Point Dr, La Jolla, CA 92037, USA
| | - Jennifer Tram
- Department of Anesthesiology, Division of Pain Medicine, University of California San Diego, 9400 Campus Point Dr, La Jolla, CA 92037, USA
| | | |
Collapse
|
11
|
The Efficacy and Safety of Glucocorticoid on Periarticular Infiltration Analgesia in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Arthroplasty 2021; 36:3340-3350. [PMID: 33926778 DOI: 10.1016/j.arth.2021.03.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/17/2021] [Accepted: 03/31/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The objective of this systematic review and meta-analysis was to examine the effect and safety of multimodal cocktail protocols implemented with or without glucocorticoids on periarticular infiltration analgesia (PIA) in patients undergoing total knee arthroplasty (TKA). METHODS We comprehensively searched the PubMed, Medline, Embase, and Cochrane Library databases up to November 2020 for randomized controlled trials on glucocorticoids as a component of the cocktail protocol used in PIA for patients with TKA. RESULTS Our meta-analysis included 11 randomized controlled trial studies with 1051 primary TKAs (930 patients). Visual analog scale scores at postoperative day (POD) 1 and POD 2 in the glucocorticoid groups were significantly lower than those in the control group (95% CI [-1.01--0.10], P = .02; 95% CI [-0.51--0.13], P = .001). Furthermore, the glucocorticoid group was associated with a statistically significant improvement in the range of motion at POD 1 (95% CI [3.20-8.05] P < .00001), reduction in total morphine consumption at 24 hours, and lower levels of C-reactive protein on POD 2/3 compared with the control group. However, neither the length of hospital stays nor the long-term Knee Society Knee Score showed any differences between the two groups. In addition, the results of subgroup analyses favored triamcinolone acetonide over betamethasone, methylprednisolone, and dexamethasone regarding the postoperative visual analog scale scores and range of motion. CONCLUSION Glucocorticoid supplementation in PIA is effective and does not increase complications or side effects for patients with either unilateral or bilateral TKA. Moreover, triamcinolone acetonide could be recommended in multimodal cocktail protocols for glucocorticoid supplementation.
Collapse
|
12
|
Huang LY, Hu HH, Zhong ZL, Teng C, He B, Yan SG. Should corticosteroids be administered for local infiltration analgesia in knee arthroplasty? A meta-analysis and systematic review. J Clin Pharm Ther 2021; 46:1441-1458. [PMID: 34254696 DOI: 10.1111/jcpt.13443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/23/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The benefits of local infiltration analgesia (LIA) in knee arthroplasty (KA) have been well-documented. However, it is unknown whether adding a corticosteroid to the composition of the LIA is beneficial. This study aimed to investigate the efficacy and safety of administering periarticular steroids intraoperatively in patients who underwent KA through a systematic review and meta-analysis. METHODS A systematic search was conducted to identify relevant randomized controlled trials in the PubMed, Embase, Web of Science and Cochrane databases up to January 19th, 2021 to perform a meta-analysis. Outcome variables included pain scores, total opioid consumption, knee range of motion (ROM) and postoperative complications. RESULTS Corticosteroid injections did not reduce pain scores at 6, 12, 24 or 72 h postoperatively, although a minimal degree of transient pain relief was achieved at 48 h postoperatively compared with those in the placebo group, nor was there a significant difference in total opioid consumption. However, patients receiving corticosteroids did exhibit a transient ROM increase on postoperative days 1, 2 and 3. Since the minimal clinically important difference (MCID) for ROM is unclear, it is unknown if the improvement in ROM is clinically significant. WHAT IS NEW AND CONCLUSION Our specific end-point analysis demonstrated that corticosteroid administration did not provide pain relief or reduce opioid consumption compared with placebo. However, corticosteroids might provide a statistically significant, though transient and minimal improvement in knee ROM after KA, although no firm conclusions about the benefits of administering corticosteroids in KA can be made based on the available evidence.
Collapse
Affiliation(s)
- Le-Yi Huang
- Zhejiang University School of Medicine, Hangzhou, China.,Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, Zhejiang University, School of Medicine, Yiwu, China
| | - Hong-Hua Hu
- Zhejiang University School of Medicine, Hangzhou, China.,Department of Dermatology, The Fourth Affiliated Hospital, Zhejiang University, School of Medicine, Yiwu, China
| | - Zhuo-Lin Zhong
- Zhejiang University School of Medicine, Hangzhou, China.,Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, Zhejiang University, School of Medicine, Yiwu, China
| | - Chong Teng
- Zhejiang University School of Medicine, Hangzhou, China.,Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, Zhejiang University, School of Medicine, Yiwu, China
| | - Bin He
- Zhejiang University School of Medicine, Hangzhou, China.,Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Shi-Gui Yan
- Zhejiang University School of Medicine, Hangzhou, China.,Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| |
Collapse
|
13
|
Yu J, Liu X. Effect of psychological intervention care on the negative mood and hope level of elderly patients undergoing knee arthroplasty. Am J Transl Res 2021; 13:6584-6591. [PMID: 34306400 PMCID: PMC8290676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We explored the influence of psychological intervention care on the negative mood and hope level of elderly patients undergoing knee arthroplasty. METHODS A total of 98 elderly patients undergoing knee arthroplasty in our hospital were randomly divided into a control group and an observation group, each with 49 people. The control group was given routine nursing care, and the observation group was given psychological intervention care plus routine nursing care. In the study, we compared the negative mood (Emotional distress Index Scale), preoperative hope level, quality of life, Range of Motion (ROM) of the knee, score of Hospital for Special Surgery (HSS), and satisfaction in the two groups of patients. RESULTS Patients in the observation group had lower Xinqing index scores than the control group (P<0.001). The scores of preoperative hope level in the observation group were higher than those of the control group (P<0.001). The scores of physical function, general health, social function, emotional role, and mental health were higher in the observation group than in the control group (all P<0.01). The ROM scores of patients in the observation group were higher than those of the control group (P<0.001). The HSS scores of patients in the observation group were higher than those of the control group (P<0.001). The patients in the observation group were significantly more satisfied with the care during hospitalization than the control group. CONCLUSION Psychological intervention care was effective for elderly patients undergoing knee arthroplasty. It could improve patients' negative mood, hope level, quality of life, and rehabilitation effects, and is worthy of clinical promotion and application.
Collapse
Affiliation(s)
- Jing Yu
- Department of Orthopedic, West China School of Nursing/West China Hospital Orthopedic Department, Sichuan University Chengdu, Sichuan Province, China
| | - Xiaoyan Liu
- Department of Orthopedic, West China School of Nursing/West China Hospital Orthopedic Department, Sichuan University Chengdu, Sichuan Province, China
| |
Collapse
|
14
|
Wang Q, Tan G, Mohammed A, Zhang Y, Li D, Chen L, Kang P. Adding corticosteroids to periarticular infiltration analgesia improves the short-term analgesic effects after total knee arthroplasty: a prospective, double-blind, randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2021; 29:867-875. [PMID: 32361928 DOI: 10.1007/s00167-020-06039-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/27/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Periarticular infiltration analgesia (PIA) is widely used to control postoperative pain in patients who underwent total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of adding corticosteroids to the PIA cocktail for pain management in patients who underwent TKA. METHODS The patients were randomized to the corticosteroid or control group (double-blind). The patients in the corticosteroid group received a periarticular infiltration of an analgesic cocktail of ropivacaine, epinephrine, and dexamethasone. Dexamethasone was omitted from the cocktail in the control group. The primary outcomes were postoperative pain [assessed using a visual analog scale (VAS)], time until the administration of first rescue analgesia, morphine consumption, and postoperative inflammatory biomarkers [C-reactive protein (CRP) and interleukin-6 (IL-6)]. The secondary outcomes were functional recovery, assessed by the range of knee motion, quadriceps strength, and daily ambulation distance. The tertiary outcomes included postoperative adverse effects. RESULTS The patients in the corticosteroid group had significantly lower resting VAS scores at 6 and 12 h after surgery, lower VAS scores during motion up to 24 h after surgery, and lower levels of inflammatory biomarkers. All the differences in the VAS scores between the two groups did not reach the point to be considered clinically significant. The additional use of corticosteroid significantly prolonged analgesic effects and led to lower rescue morphine consumption. The patients in the corticosteroid group had significantly better functional recovery on the first day after surgery. The two groups had a similar occurrence of adverse effects. CONCLUSIONS Adding corticosteroids to an analgesic cocktail for PIA could lightly improve early pain relief and accelerate recovery in the first 24 h after TKA. LEVEL OF EVIDENCE Randomized controlled trial, Level I.
Collapse
Affiliation(s)
- Qiuru Wang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Gang Tan
- Department of Orthopaedics Surgery, West China Fourth Hospital, Sichuan University, 18# Section 3, Renmin South Road, Chengdu, 610041, People's Republic of China
| | - Alqwbani Mohammed
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yueyang Zhang
- School of Public Health, Shandong University, 44# Wenhua West Road, Jinan, 250012, People's Republic of China
| | - Donghai Li
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Liyile Chen
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Pengde Kang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
| |
Collapse
|
15
|
Yano T, Imaizumi T, Matsu-Ura H, Takahashi T. Relationship between dexamethasone added to periarticular anesthetic infiltration and postoperative nausea and vomiting following total knee arthroplasty under general anesthesia: a retrospective observational study. JA Clin Rep 2020; 6:66. [PMID: 32822007 PMCID: PMC7442779 DOI: 10.1186/s40981-020-00372-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/14/2020] [Indexed: 12/26/2022] Open
Abstract
Background Periarticular anesthetic infiltration (PAI) with a corticosteroid is a modality for pain control following total knee arthroplasty (TKA). Systemic corticosteroids are an established antiemetic for the prophylaxis of postoperative nausea and vomiting (PONV). The purpose of this retrospective observational study was to elucidate the relationship between dexamethasone added to PAI and PONV in patients who underwent TKA. Methods Data from 435 patients who received PAI using ropivacaine with or without dexamethasone were reviewed. The primary outcome was the incidence of PONV within 24 h following TKA. The incidence of deep incisional and organ/space surgical site infection (SSI) within the first year was also assessed. Results The overall incidence of PONV was 23.2%. A multivariate logistic regression analysis showed that dexamethasone added to PAI was independently associated with a reduced incidence of PONV (adjusted odds ratio, 0.23; 95% confidence interval, 0.12–0.44, P < 0.001). The incidence of PONV and rescue analgesic requirements within 24 h were lower in patients who received PAI with dexamethasone than in those who received PAI alone (19.5% vs 49.1%, P < 0.001, 7.9% vs 29.1%, P < 0.001, respectively). SSI developed in one out of the 55 patients who received PAI alone, but in none of those who received PAI with dexamethasone. Conclusions Dexamethasone added to PAI for postoperative pain management was independently associated with a lower risk of PONV within 24 h of TKA.
Collapse
Affiliation(s)
- Toshiyuki Yano
- Division of Anesthesia, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kita-ku, Kumamoto, 860-8518, Japan.
| | - Takashi Imaizumi
- Division of Anesthesia, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kita-ku, Kumamoto, 860-8518, Japan
| | - Hidemi Matsu-Ura
- Department of Pharmacy, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kita-ku, Kumamoto, 860-8518, Japan
| | - Tomoki Takahashi
- Department of Orthopedic Surgery, Kumamoto Kinoh Hospital, 6-8-1 Yamamuro, Kita-ku, Kumamoto, 860-8518, Japan
| |
Collapse
|
16
|
Roecker Z, Quinlan ND, Browne JA, Werner BC. Risk of Periprosthetic Infection Following Intra-Articular Corticosteroid Injections After Total Knee Arthroplasty. J Arthroplasty 2020; 35:1090-1094. [PMID: 31813813 DOI: 10.1016/j.arth.2019.11.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recent literature has advocated for the effectiveness of postoperative steroid injections following total knee arthroplasty (TKA) for improving pain and range of motion when other correctible causes of these symptoms have been eliminated. The safety of such injections has not been thoroughly evaluated. The aim of this study was to determine the risk of acute infection following intra-articular corticosteroid injection into a preexisting TKA. METHODS The Humana dataset was used to identify patients who underwent TKA from 2007 to 2017. Patients with ipsilateral knee corticosteroid injections in the postoperative period were then identified and compared to a 2:1 matched control cohort. A diagnosis of infection within 6 months and 1 year following the injection and an ipsilateral procedure for infection at any time postoperatively were then assessed and compared to controls using a multivariate binomial logistic regression analysis. RESULTS Of the 166,946 TKA performed during the study period, 5628 patients had a postoperative corticosteroid injection (3.4%). Patients with injections had a significantly higher rate of periprosthetic infection compared to noninjection matched controls at all studied time points. CONCLUSION In a large national database, about 3% of patients who undergo TKA have a postoperative steroid injection into their postoperative knee. While there is some existing literature demonstrating improvement in pain and stiffness symptoms after TKA with postoperative injections, the present study demonstrates a significant correlation between postoperative intra-articular corticosteroid injections in patients with preexisting TKA and periprosthetic joint infection compared to matched controls who did not receive an injection.
Collapse
Affiliation(s)
- Zoe Roecker
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Nicole D Quinlan
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| |
Collapse
|
17
|
Kim JI, Kim YT, Jung HJ, Lee JK. Does adding corticosteroids to periarticular injection affect the postoperative acute phase response after total knee arthroplasty? Knee 2020; 27:493-499. [PMID: 31806506 DOI: 10.1016/j.knee.2019.10.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/08/2019] [Accepted: 10/31/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Periarticular injection (PAI) can reduce pain and improve early outcomes following total knee arthroplasty (TKA). Although corticosteroid PAI has been reported to be safe and effective, investigations on the postoperative acute phase response (APR) are scarce. METHODS This retrospective cohort study with propensity score matching investigated two groups of patients after TKA: the steroid group (n = 50) received an intraoperative corticosteroid PAI (methylprednisolone 40 mg); the non-steroid group (n = 50) did not receive the corticosteroid. To evaluate the APR, C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR) were determined preoperatively and on postoperative day (POD) 2, 4, 6, 14, and 28. A visual analogue scale (VAS) was used to measure pain on the night of surgery and on POD 1, 2, 4, and 6. Maximal flexion at discharge (POD 7), morphine equivalent dose (MED), and complications were also evaluated. RESULTS The steroid group showed significantly lower CRP levels on POD 2 (P < .05) and POD 4 (P < .05) but a higher CRP level on POD 6 (P < .05). However, ESR levels did not differ between the two groups in all measurements. Peak values in CRP and ESR in the steroid group (POD 4 and 6) appeared two days later compared with the non-steroid group (POD 2 and 4). The VAS pain score was significantly lower in the steroid group on POD 2 (P < .05). Maximal flexion on discharge, MED and complication rate were similar in the two groups. CONCLUSIONS Adding a corticosteroid to the PAI following TKA attenuated the APR, and also provided significant pain relief.
Collapse
Affiliation(s)
- Joong Il Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul, South Korea.
| | - Yong Tae Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul, South Korea
| | - Ho Jung Jung
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul, South Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro, 170beon-gil, Dongan-gu, Anyang-si, South Korea
| |
Collapse
|