Anterior vs Posterior Periarticular Multimodal Drug Injections: A Randomized, Controlled Trial in Simultaneous Bilateral Total Knee Arthroplasty

Laoruengthana, Artit; Rattanaprichavej, Piti; Rasamimongkol, Supachok; Galassi, Monton

doi:10.1016/j.arth.2017.02.033

Cited by 27 publications

(19 citation statements)

References 25 publications

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“…They reported 73.9% of patients were satisfied with the left knee more than another side. Although, there were various studies assessing the outcomes of periarticular injection between knees in SBTKA with different techniques [17, 23, 24], there was a paucity of information in the confounding effect of the time lag between the injections. In this study, we assessed the confounding effect of the interval between PMDI and noticed that this factor did not confound the comparison of postoperative VAS, the degree of knee flexion, SLR, and EL between knees within the same patient at any point of time.…”

Section: Discussionmentioning

confidence: 99%

“…Statistical significance was defined as p -value < 0.05. A sample size of 48 knees for each group was anticipated to detect a difference in VAS between early and late PMDI, with a standard deviation of 1.5 [17], 90% power, and a significance level alpha of 0.05. Collecting repeated measurements of the outcome variables with GEE analysis accounted for within-person change across time, resulted in increased statistical power for detecting changes while reducing the costs of conducting a study.…”

Section: Methodsmentioning

confidence: 99%

“…The periarticular injection has been reported of providing better pain relief and diminishing of opioid-related adverse effect in the first 24 h after simultaneous bilateral total knee arthroplasty (SBTKA) when compared to epidural analgesia [16]. By improving the efficacy of the PMDI, the proper location of periarticular injection can reduce postoperative pain and improve quadriceps function [17]. The ingredients of the mixture could also influence on pain scores, opioid consumption, and range of motion following TKA [18].…”

Section: Introductionmentioning

confidence: 99%

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Timing of periarticular injection has no effect on postoperative pain and functional recovery in simultaneous bilateral total knee arthroplasty: a prospective randomized, double-blinded trial

Laoruengthana

Jarusriwanna

Rattanaprichavej

et al. 2019

BMC Musculoskelet Disord

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Background Given no consensus on optimal timeframe of periarticular multimodal drug injection (PMDI) in knee osteoarthritis patients undergoing total knee arthroplasty (TKA), this study was aimed to compare the postoperative pain and the functional recovery in patients who underwent simultaneous bilateral TKA (SBTKA) and received PMDI at the different intraoperative time points. Methods This prospective, randomized, double-blinded controlled trial study included 48 patients who underwent SBTKA and received PMDI mixture, either before prosthetic implantation (late PMDI), or just after knee arthrotomy (early PMDI). Each subject’s knees were randomly selected to different PMDI administration time points. The outcome parameters were postoperative pain assessed by using a visual analog scale (VAS), the maximal angle of knee flexion, and quadriceps function from day 1 to 6 weeks after surgery. Results Late PMDI revealed slightly higher VAS at 6 and 12 h after the operation than early PMDI administration. Afterward, the VAS tended to be lower in the late than early PMDI administration until the end of the study, but without statistical significance. The time difference between early and late PMDI had no effect on postoperative VAS, while older age resulted in significantly less pain. No statistical differences between the two groups in all other outcome parameters were observed. Conclusions Postoperative pain reduction and functional recovery of SBTKA with early and late PMDI administration were not significantly different. The time interval of PMDI between knees did not confound the comparison of postoperative pain and functional recovery in SBTKA. Trial registration The protocol of this study was retrospectively registered in the Thai Clinical Trials Registry database No. TCTR20170617001 on 16 June 2017.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Timing of periarticular injection has no effect on postoperative pain and functional recovery in simultaneous bilateral total knee arthroplasty: a prospective randomized, double-blinded trial

Laoruengthana

Jarusriwanna

Rattanaprichavej

et al. 2019

BMC Musculoskelet Disord

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“…13) Tammachote and Kanitnate 14) also revealed that administration of 0.15 mg/ kg of intravenous dexamethasone can significantly relieve pain between 12 hours to 21 hours after TKA and reduce rates of PONV and level of C-reactive protein compared with placebo, but might be associated with transient hyperglycemia. On the other hand, the efficacy of PAI might also be improved by some strategies such as location of injection 15) or adding some adjuvants to the PAI mixture. 8,16) Alternatively, additional peripheral nerve block could also be considered as an analgesic supplement to overwhelm the pain after TKA.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Outcomes of Patients Who Were Not Candidates for Additional Nonsteroidal Anti-inflammatory Drugs in a Multimodal Pain Control Regimen for Total Knee Arthroplasty

et al. 2021

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“…Inadequate pain management following TKA may influence the functional recovery, increase opioid consumption, and contribute to several complications [ 24 ]. Recently, multimodal pain management has been widely applied in TKA [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of intravenous acetaminophen in multimodal management for pain relief following total knee arthroplasty: a meta-analysis

et al. 2018

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BackgroundThe efficacy of intravenous acetaminophen in multimodal pain management in patients undergoing total knee arthroplasty (TKA) is controversial. The purpose of this meta-analysis was to compare the efficacy of intravenous acetaminophen versus placebo in TKA.MethodsRandomized controlled trials (RCTs) or retrospective cohort studies (RCSs) concerning related topics were retrieved from PubMed (1996–June 2018), Embase (1980–June 2018), and the Cochrane Library (CENTRAL June 2018). Any studies comparing intravenous acetaminophen with a placebo were included in this meta-analysis. Meta-analysis results were collected and analyzed by Stata 12.0. Subgroup analysis was performed according to the general characteristics of the patients.ResultsIn total, the patients from six studies met the inclusion criteria. Our meta-analysis results indicated that compared with a control group, intravenous acetaminophen was associated with reductions in total morphine consumption and visual analogue scale (VAS) score at postoperative day (POD) 3. However, there was no significant difference in morphine consumption at POD 1 or in VAS at POD 1 or POD 2. Moreover, there was no significant difference in the length of hospital stay.ConclusionsBased on our results, intravenous acetaminophen in multimodal management has shown better efficacy in pain relief at POD 3 and has morphine-sparing effects. High-quality studies with more patients are needed in the future.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0950-7) contains supplementary material, which is available to authorized users.

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Anterior vs Posterior Periarticular Multimodal Drug Injections: A Randomized, Controlled Trial in Simultaneous Bilateral Total Knee Arthroplasty

Cited by 27 publications

References 25 publications

Timing of periarticular injection has no effect on postoperative pain and functional recovery in simultaneous bilateral total knee arthroplasty: a prospective randomized, double-blinded trial

Timing of periarticular injection has no effect on postoperative pain and functional recovery in simultaneous bilateral total knee arthroplasty: a prospective randomized, double-blinded trial

Perioperative Outcomes of Patients Who Were Not Candidates for Additional Nonsteroidal Anti-inflammatory Drugs in a Multimodal Pain Control Regimen for Total Knee Arthroplasty

Efficacy of intravenous acetaminophen in multimodal management for pain relief following total knee arthroplasty: a meta-analysis

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