Efficacy of Periarticular Cocktail Injection in Rheumatoid Patients Undergoing Total Knee Replacement

Martin, Nikhil Joseph; Padmanabhan, Vinod; Pindis, Johny Joseph

doi:10.1007/s43465-020-00230-3

Cited by 7 publications

(3 citation statements)

References 49 publications

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“…Postoperative pain was the predominant reason for the patients in the control group not starting ambulation on Day 1. A study by Martin et al reported similar findings that ambulation was significantly improved with the use of intraoperative cocktail injections [ 18 ].…”

Section: Discussionmentioning

confidence: 78%

Efficacy of Intraoperative Periarticular Local Infiltration for Pain Control and Ambulation in Total Knee Arthroplasty: A Randomized Case-Control Study

KG,

2024

Cureus

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Introduction: Total knee arthroplasty (TKA) is a leading operative procedure for late-stage knee osteoarthritis. The cornerstone of a successful TKA is swift and effective rehabilitation to achieve a pain-free and good range of motion. Pain post-replacement hinders an effective rehabilitation protocol. Reported preoperative, perioperative, and postoperative analgesia modes have undesirable side effects. The purpose of this study is to assess the effect of a unique cocktail injection on immediate postoperative pain using the visual analog score, the need for additional analgesics during the initial period, and the ambulation time between the case and control groups. Materials and methods: In this randomized case-control study, the periarticular injection consisted of ropivacaine 0.75 mg/ml (28 ml), epinephrine 1 mg/ml (0.5 ml), and ketorolac 30 mg/ml (1 ml) added to 50 ml of normal saline to make 80 ml of solution. Fifty patients were chosen and randomly divided into two groups of 25 each by computer-generated randomization. The case group received the cocktail injection, and the control group was injected locally with normal saline. Visual analog scale (VAS) was assessed at 3, 6, 12, and 24 hr post-surgery, and the amount of additional analgesics used and ambulation time were assessed. Results: A total of 50 patients who underwent TKA were selected and divided into case and control groups of 25 each. The majority of the patients had osteoarthritis, and a few had rheumatoid arthritis. No significant differences in demographic data (age, gender, body-mass index) or surgical time. The case group had excellent VAS scores between 0 and 3 at 3, 6, 12, and 24 hr (p < .001). The amount of additional analgesia required in the case group was minimal (<3 doses) in 96% of the patients on Day 1. More than 80% of patients could ambulate pain-free on Day 1. Conclusion: Pain reduction with early ambulation was noted in a significant number of individuals with the use of this unique intraoperative local cocktail injection. This pain-free initial period following TKA prepared patients for an effective rehabilitation program.

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Section: Discussionmentioning

confidence: 78%

Efficacy of Intraoperative Periarticular Local Infiltration for Pain Control and Ambulation in Total Knee Arthroplasty: A Randomized Case-Control Study

KG,

2024

Cureus

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“…Martin et al in their study stated that the post-operative healing following in total knee replacement has been revolutionized by the use of a combination of an efficient, technologically well-driven periarticular cocktail injection, a multimodal supplemental pain program, as well as the application of tranexamic acid to limit bleeding. When it comes to pain control, the multimodal approach has exceptionally high patient contentment [ 37 ]. Additionally, patients may be able to prevent the necessity and dangers of a subsequent peripheral nerve block surgery.…”

Section: Reviewmentioning

confidence: 99%

A Review on the Efficacy of Extraosseous Local Infiltration of Multimodal Drug Cocktail for Pain Management After Total Knee or Hip Arthroplasty

Salwan¹,

Pisulkar²,

Taywade³

et al. 2022

Cureus

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Total knee arthroplasty (TKA) patients express minimal comfort regarding postoperative pain management. The use of parenteral opioids or epidural analgesia may have unfavorable adverse impacts that interfere with quick healing and rehabilitation. It is uncertain if periarticular multimodal drug injections (PMDI) are effective at easing pain following total knee or total hip arthroplasty (THA). We conducted this study to assess the effectiveness of PMDI following TKA or THA. Articles were sourced using the following keywords on Pubmed, Google scholar, and the Web of Science: multimodal drug cocktail in total knee arthroplasty OR hip arthroplasty, periarticular injections AND multimodal drug cocktail, epidural versus periarticular injections AND pain management after total joint arthroplasty. After screening 438 articles and abstracts, 200 pertinent studies were found, of which a total of 10 articles were included in the study. From this review, we want to conclude that despite the various ways to address postoperative pain, there is no acknowledged gold standard for postoperative pain management following total joint arthroplasty. To reduce narcotic intake and prevent narcotic-related adverse reactions, multimodal techniques utilizing regional anesthetics appear to be on the rise such as periarticular injections, or patient-controlled analgesia with or without femoral nerve block. Even though the ideal duration and kind of medications are unclear, preoperative pain management or preemptive analgesia with anti-inflammatory drugs and opioid analgesics seem to be useful in lowering postoperative pain.

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“…Martin presented the benefits of injecting caquester into the joints of patients who were resolved after the seat frame was fixed. His study included 64 patients with rheumatoid arthritis who also underwent initial total knee arthroplasty [1]. e term "large knee surgery" includes anterior cruciate ligament reconstruction, knee lysis, and total knee replacement.…”

Section: Related Workmentioning

confidence: 99%

Observation and Analysis of the Postoperative Analgesic Effect of Subanaesthetic Dose of Ketamine in Kashin–Beck Disease Patients after Total Knee Arthroplasty

Xie

Zhu

et al. 2022

Journal of Healthcare Engineering

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With the transformation of modern medical models, the medical needs of patients have changed from treatment to safe, comfortable, and painless treatment. Therefore, it is clinically important to find an ideal analgesia model to reduce the pain after total knee arthroplasty and minimize the impact of surgical trauma on the body pressure. This article aims to study the effects of lower limb nerve block combined with local infiltration analgesia of the joint cavity on the hemodynamics and postoperative analgesia effects of knee joint replacement in elderly patients by comparing the effects of the subanaesthetic dose of ketamine on the hemodynamics and postoperative analgesia effect of knee joint replacement in elderly patients’ intraoperative analgesia program. This article proposes that 90 patients requiring unilateral total knee replacement were randomly divided into 3 groups, with 30 patients in each group, age 65–85 years, average age 75 years, ASA I ∼ II grade, and body mass index 13.89 ∼ 37.26. Use a multifunctional monitor to monitor the patient’s continuous blood pressure (SBP/DBP) and mean arterial pressure (MAP), heart rate (HR), electrocardiogram (ECG), intraoperative pulse oxygen saturation (SpO2), and end-tidal carbon dioxide (PETCO2). The following are monitored: record the heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure before induction of anesthesia (T0), before the upper tourniquet (T1), and after the upper tourniquet (T2), before tourniquet withdrawal (T3), and after tourniquet withdrawal (T4), mean arterial pressure (MAP). The three groups of patients had different degrees of itching, vomiting, nausea, and other adverse reactions. The experimental results in this article show that, in elderly patients with epidural anesthesia, the use of propofol and dexmedetomidine to maintain the patient’s BIS value between 60 and 70 can meet the depth of sedation required for surgery without important surgical operation knowledge.

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Efficacy of Periarticular Cocktail Injection in Rheumatoid Patients Undergoing Total Knee Replacement

Cited by 7 publications

References 49 publications

Efficacy of Intraoperative Periarticular Local Infiltration for Pain Control and Ambulation in Total Knee Arthroplasty: A Randomized Case-Control Study

Efficacy of Intraoperative Periarticular Local Infiltration for Pain Control and Ambulation in Total Knee Arthroplasty: A Randomized Case-Control Study

A Review on the Efficacy of Extraosseous Local Infiltration of Multimodal Drug Cocktail for Pain Management After Total Knee or Hip Arthroplasty

Observation and Analysis of the Postoperative Analgesic Effect of Subanaesthetic Dose of Ketamine in Kashin–Beck Disease Patients after Total Knee Arthroplasty

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