Paper #IV-2
 
A RANDOMISED BLINDED CLINICAL TRIAL ASSESSING EFFICACY OF PERI-ARTICULAR INJECTION USING MULTIMODAL ANALGESIA IN TOTAL KNEE REPLACEMENT
 
 
Benjamin Shore, MD
London, ON
 
Co-Authors
Constant A Busch FRCS (Tr and Orth)
Steven J MacDonald, MD
Robert B Bourne, MD
Cecil H Rorabeck, MD
Richard W McCalden, MD
Sugantha Ganapathy, MD
Rakesh Bhandari, MD
 
 
Background
Post-operative analgesia using parenteral opioids or epidural analgesia can be associated with troublesome side effects. Good peri-operative analgesia facilitates rehabilitation, improves patient satisfaction and may reduce hospital stay. 
 
Materials and Methods
64 patients undergoing total knee replacement were randomized to receive either a peri-articular intra-operative injection containing ropivacaine, ketorolac, epimorphine and epinephrine or no injection. The anesthetic regime was standardized. All patients received patient controlled analgesia (PCA) for 24 hours post surgery, followed by standard analgesia. Visual analogue scale (VAS) pain scores during activity and at rest and patient satisfaction scores were recorded pre-operatively, post-operatively and at 6 week follow up. PCA consumption and analgesic requirement were measured.
 
Results
PCA use at 6, 12 and 24 hours post surgery was significantly less in patients receiving the injection (P=0.004, 0.032, 0.005). Patient satisfaction at 4 and 24 hours post-operatively was greater (P=0.015, 0.040). VAS for pain during activity and rest at 4 hours was significantly less (P=0.013, 0.017) in the injected group. Overall hospital stay, ROM at 6 weeks and the incidence of wound complications was not different between the 2 groups.
 
Conclusion
Peri-articular intra-operative analgesia significantly reduces post-operative analgesia requirement. Post-operative patient satisfaction is greater in the injection group.