Background:Pain after total knee arthroplasty (TKA) is a big problem in orthopaedic surgery. Although opioids and continuous epidural analgesia remain the major options for the postoperative pain management of TKA, they have some undesirable side effects. Epidural analgesia is technically demanding, and the patient requires close monitoring. Different types of local anesthetic applications can successfully treat TKA pain. Local anesthetics have the advantage of minimizing pain at the source. This study investigates the efficacy of different local anesthetic application methods on early, (1st day) pain control after total knee arthroplasty.Materials and Methods:200 patients who underwent unilateral TKA surgery under spinal anesthesia were randomly assigned into four different groups (fifty in each group) and were administered pain control by different peri- and postoperative regimens. Group A was the control group wherein no postsurgical analgesia was administered to assess spinal anesthesia efficacy; in Group B, only postsurgical one-shot femoral block was applied; in Group C, intraoperative periarticular local anesthetic was applied; in Group D, a combination of the one-shot femoral block and intraoperative periarticular local anesthetics were applied. Demographic data consisting of age, weight, gender and type of deformity of patients were collected. The data did not differ significantly between the four groups.Results:Group D patients experienced significantly better postoperative pain relief (P < 0.05) and were therefore more relaxed in pain (painless time, VAS score) and knee flexion (degrees) than the other patient groups in the 1st postoperative day followup. Painless time of Group D was 10.5 hours and was better than Group C (6.8 hours), Group B (6.2 hours) and Group A (3.0 hours) (P < 0.05). Group A got the best pain Vas score degrees in the 1st postoperative day which showed the success of combined periarticülar local anesthetic injection and femoral nerve block.Conclusion:The intraoperative periarticular application of local anesthetics in addition to one-shot femoral block is an efficient way of controlling postsurgical pain after TKA.

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Background and Aim: There are few nonsurgical options for treatment of grade IV knee osteoarthritis. This randomised controlled clinical trial was performed to evaluate the efficacy and safety of intra-articular injection of local anaesthetic and corticosteroid for pain management in patients with grade IV osteoarthritic knee joints. Methods: A total of 240 patients with grade IV osteoarthritic knee joints were enrolled and separated into four groups. They were administered different intra-articular injections: Group A received local anaesthetic (prilocaine); Group B received methylprednisolone; Group C received methyl-prednisolone+ saline; and Group D received methylprednisolone+prilocaine. The number of pain-free days following injection was recorded. Results: The mean number of pain-free days was 3.7±0.2days in Group A vs.62.1±0.3 days in Group B vs. 75.5±0.8 days in Group C vs. 157±0.5 days in Group D (P<0.05). Patients were asked to report to the clinic if pain recurred and the same injection was repeated. After the second injection, once again, the number of pain-free days was significantly higher in Group D (161 days) than in the other groups. Adverse events encountered included syncope (n=14) and cellulitis at injection site (n=2). Conclusion: Intra-articular combination of methylprednisolone and prilocaine appears to be a safe and effective method for potentiating pain relief in grade IV knee osteoarthritis. The injection can be repeated at intervals to provide a permanent pain-free knee for patients.

Aim: This study aimed to evaluate the presence of the Palmaris Longus Tendon (PLT)