Efficacy of Opioids in Preemptive Multimodal Analgesia for Total Knee Arthroplasty: A Prospective, Double-Blind, Placebo-Controlled, Randomized Trial

In the current Guest Editorial, we evaluate and summarize the most relevant findings from recent, meaningful, peer-reviewed publications in different research areas. Articles at various Levels of Evidence were included, but increased attention was paid to Level-I and award-winning reports. EconomicsConsiderable debate continues with regard to the economics of reconstructive knee surgery. An updated Medicare projection revealed that, by 2040, the annual number of revision total knee arthroplasties (TKAs) performed would be 115,147, whereas, by 2060, it would be 286,740. These values are important for understanding the future health-care resource utilization involving revision TKA, which is only expected to increase 1 . A secondary analysis of a randomized clinical trial (RCT) evaluating health-care resource utilization up to 12 months after primary TKA, among dissatisfied and satisfied patients, showed that patients dissatisfied with their return to function incurred a mean cost of $19,007.70, compared with $13,523.83 for satisfied patients (p = 0.07). Although the cost difference was not significant, its magnitude deserves attention 2 . Data from the New Zealand Joint Registry indicated that patients undergoing TKA have a mortality rate 8% higher than that of the general population 3 . Assessing mortality after primary TKA is relevant for future economic analyses.

Section: Anesthesia and Pain Managementmentioning

confidence: 83%

What’s New in Adult Reconstructive Knee Surgery

Villa,

Hosseinzadeh,

Higuera-Rueda

2023

“…The materials and methods, including the patient enrollment, randomization process, surgery, outcomes, follow-up, and data analysis, have been reported previously [22][23][24] .…”

Section: Methodsmentioning

confidence: 99%

Efficacy of a Modified Cocktail for Periarticular Local Infiltration Analgesia in Total Knee Arthroplasty

Wang

Zhao

et al. 2023

Self Cite

Background:Periarticular local infiltration analgesia (LIA) is largely utilized for controlling pain after total knee arthroplasty (TKA). The present work aimed to assess the efficacy of a modified LIA cocktail for patients undergoing TKA.Methods:Magnesium sulfate (MgSO4) and sodium bicarbonate (NaHCO3) were added to a conventional LIA cocktail comprising ropivacaine, epinephrine, and dexamethasone. After the safety of this modified cocktail was tested in rats, its efficacy and safety were evaluated in a prospective, double-blinded study including 100 individuals randomized to receive periarticular infiltration of the modified cocktail or a conventional cocktail. The primary outcome was postsurgical use of morphine hydrochloride for rescue analgesia. Secondary outcomes were the time until the first rescue analgesia, postsurgical pain (on a visual analog scale [VAS]), functional recovery (assessed by range of knee motion and ambulation distance), time to discharge, and complication rates.Results:Adding NaHCO3 to the local anesthetics caused some instantaneous precipitation in all cases. Administering the modified cocktail to rats did not obviously damage the injected area of the nerve or surrounding tissues. Administration of the modified cocktail to patients was associated with markedly reduced postsurgical morphine use in the initial 24 hours (4.2 ± 5.0 versus 14.6 ± 8.9 mg, p < 0.001), reduced total morphine use (9.8 ± 8.4 versus 19.6 ± 11.4 mg, p < 0.001), prolonged time to the first rescue analgesia, lower VAS pain scores at rest and during motion at 12 and 24 hours following the operation, better functional recovery on postoperative days 1 and 2, and a shorter hospital stay. The modified and conventional cocktail groups had similar rates of complications.Conclusions:The present modification of a conventional cocktail significantly prolonged analgesia and reduced opioid consumption, which may substantially improve pain control in arthroplasty.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

“…We obtained this information prior to patient enrollment from patients who were not included in the trial. The materials and methods are partially based on previous studies [22][23][24] .…”

Section: Methodsmentioning

confidence: 99%

Efficacy of Diosmin in Reducing Lower-Extremity Swelling and Pain After Total Knee Arthroplasty

Wang,

Jin,

Cai

et al. 2023

Self Cite

Background: Many patients experience lower-extremity swelling following total knee arthroplasty (TKA), which impedes recovery. Diosmin is a semisynthetic flavonoid that is often utilized to treat swelling and pain caused by chronic venous insufficiency. We aimed to evaluate the efficacy and safety of diosmin in reducing lower-extremity swelling and pain as well as in improving functional outcomes following TKA. Methods: This study was designed as a randomized, controlled multicenter trial and conducted in 13 university-affiliated tertiary hospitals. A total of 330 patients undergoing TKA were randomized to either receive or not receive diosmin postoperatively. The diosmin group received 0.9 g of diosmin twice per day for 14 consecutive days starting on the day after surgery, whereas the control group received neither diosmin nor a placebo postoperatively. The primary outcome was lower-extremity swelling 1, 2, 3, and 14 days postoperatively. The secondary outcomes were postoperative pain assessed with use of a visual analogue scale, Hospital for Special Surgery score, range of knee motion, levels of the inflammatory biomarkers C-reactive protein and interleukin-6, and complications. Results: At all postoperative time points, diosmin was associated with significantly less swelling of the calf, thigh, and upper pole of the patella as well as with significantly lower pain scores during motion. However, no significant differences in postoperative pain scores at rest, Hospital for Special Surgery scores, range of motion, levels of inflammatory biomarkers, or complication rates were found between the diosmin and control groups. Conclusions: The use of diosmin after TKA reduced lower-extremity swelling and pain during motion and was not associated with an increased incidence of short-term complications involving the outcomes studied. However, further studies are needed to continue exploring the efficacy and safety of diosmin use in TKA. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.