Gonyautoxins 2/3 Local Periarticular Injection for Pain Management after Total Knee Arthroplasty: A Double-Blind, Randomized Study

Abstract

The purpose of this study was to compare the efficacy of periarticular infiltration of gonyautoxin 2/3 (GTX 2/3) and a mixture of levobupivacaine, ketorolac, and epinephrine for pain management after total knee arthroplasty (TKA). Forty-eight patients were randomly allocated to receive periarticular infiltration of 40 µg GTX 2/3 (n = 24) diluted in 30 mL of sodium chloride 0.9% (study group) or a combination of 300 mg of levobupivacaine, 1 mg of epinephrine, and 60 mg ketorolac (n = 24) diluted in 150 mL of sodium chloride 0.9% (control group). Intraoperative anesthetic and surgical techniques were identical for both groups. Postoperatively, all patients received patient-controlled analgesia (morphine bolus of 1 mg; lockout interval of 8 minutes), acetaminophen, and ketoprofen for 72 hours. A blinded investigator recorded morphine consumption, which was the primary outcome. Also, the range of motion (ROM) and static and dynamic pain were assessed at 6, 12, 36, and 60 hours after surgery. The incidence of adverse events, time to readiness for discharge, and length of hospital stay were also recorded. The median of total cumulative morphine consumption was 16 mg (range, 0–62 mg) in the GTX 2/3 group and 9 mg (range, 0–54 mg) in control group, which did not reach statistical difference (median test, p = 0.40). Furthermore, static and dynamic pain scores were similar at all time intervals. GTX 2/3 was inferior in range of motion at 6 and 12 hours; nevertheless, we noted no difference after 36 hours. No differences between groups were found in terms of complications, side effects, or length of hospital stay. No significant differences were found between groups in terms of breakthrough morphine requirement. However, local anesthetic use resulted in an increased ROM in the first 12 hours. This prospective randomized clinical trial shows that GTX 2/3 is a safe and efficient drug for pain control after TKA; nevertheless, more studies using GTX 2/3 with larger populations are needed to confirm the safety profile and efficiency. This is level 1 therapeutic study, randomized, double-blind clinical trial.

Anterior knee pain and sit-up tests predicts patients’ satisfaction and improvement in quality of life after anterior stabilized total knee replacement without patellar resurfacing

“…The TUG test corresponds to the time it takes for a patient to get up from a chair, walk 1.5 meters in a straight line, turn around, and return. The time was recorded in seconds [22]. For the sit-up test, the patient was asked to complete as many sit-and-stand cycles as quickly as possible in 30 seconds with their arms crossed over their chest.…”

Periarticular infiltration used in total joint replacements: an update and review article

“…80 mg triamcinolone acetonide as an additive to unspecified PAI cocktail 60 mg periarticular infiltration no significant difference in pain relief in comparison at 0, 24, 48, 72 h postop Ketorolac showed no significant difference in morphine consumption, VAS scores, postoperative knee extension or straight leg tests immediately after surgery, 24 h, 48, or 72 h postoperatively when compared to the triamcinolone additive. Postoperative knee flexion was decreased in the ketorolac injection group compared to the triamcinolone group Not documented Hinzpeter et al [ 40 ] RCT 48 patients receiving TKA 1. Periarticular infiltration receiving 40 µg of gonyautoxin 2/3 (GTX 2/3) in saline (study group) 2.…”

“…Ketorolac's recommended IM and IV dose is 30 mg as a one-time dose or 30 mg every 6 h up to a maximum total of 120 mg in 24 h [ 51 ]. Still, some studies also describe 60 mg as a dosage option[ 39 , 40 ] with a possible dose-dependent response [ 49 , 52 ]. Many studies included visual analog scale (VAS) scores and opioid usage as measures of effectiveness for postoperative pain management.…”

“…All but two studies [ 39 , 45 ] that explored subjective pain scores found improved postoperative pain when ketorolac was added to the PAI. Decreased opioid usage was reported by Nikhar [ 3 ], Tammachote [ 47 ] and Andersen [ 37 ], but opioid usage was otherwise not significantly reduced [ 38 – 40 ]. Improvements in postoperative function, including range of motion [ 39 , 40 , 42 , 44 – 46 ] and time to home readiness [ 37 ], were also investigated and were generally favorable, with some exceptions [ 39 , 45 ].…”

“…Decreased opioid usage was reported by Nikhar [ 3 ], Tammachote [ 47 ] and Andersen [ 37 ], but opioid usage was otherwise not significantly reduced [ 38 – 40 ]. Improvements in postoperative function, including range of motion [ 39 , 40 , 42 , 44 – 46 ] and time to home readiness [ 37 ], were also investigated and were generally favorable, with some exceptions [ 39 , 45 ]. Complications in the studies with ketorolac infiltration were rare, with one episode of hematoma [ 37 ] and one episode of DVT [ 43 ] highlighted across the studies.…”