Percutaneous intra-articular injections of ropivacaine, and tranexamic acid and removal of the drainage tube one day after total knee arthroplasty as a component of enhanced recovery after surgery: a randomized control trial

Abstract

Background: Intraoperative injections of ropivacaine and tranexamic acid have an increasing role as part of analgesia and haemostasis for enhanced recovery after Total Knee Arthroplasty. However, drug efficiency gradually disappears one day after surgery. Drainage tube placed for too long can cause various complications. This study evaluates whether the postoperative injections of ropivacaine, and tranexamic acid and removal of the drainage tube one day would promote recovery after TKA. Methods: A total of 80 participants were randomly assigned to two groups. One group was treated with additional intra-articular injections at 08:30 on postoperative day 1 and the removal of drainage tube simultaneously (Trial Group). Another group was dealt with no injection and removal of the drainage tube responding to the amount of drainage fluid (Control Group). The multi-drug solution included 100 mg ropivacaine, and 1 g tranexamic acid, and 10 mL saline. The primary outcomes assessed included visual analog scale score, length of hospital stay after surgery, the circumference of the knee, total blood loss volume. Results: The group that received an additional intra-articular injection of ropivacaine had a significantly lower area under the curve for visual analog scale score than the no injection group at rest (424 ± 32 compared with 515 ± 39, p = 0.003). The Trial Group can reduce the length of hospital stay after surgery over the Control Group (7.1 ± 3.1 days compared with 8.7 ± 3.2 days, p = 0.003). The group that received an additional intra-articular injection of tranexamic acid have no difference in total blood loss volume & the circumference of knee joint over the no additional intra-articular injection group (910.6 ± 385.3 mL compared with 974.8 ± 408.2 mL, p=0.47 & 38.9 ±5.4cm compared with 38.8±2.4cm，p=0.91). Conclusions: Intra-articular injection of ropivacaine, and tranexamic acid and removal of the drainage tube one day after TKA can further promote recovery after TKA. Keywords: enhanced recovery after surgery, total knee arthroplasty, tranexamic acid, ropivacaine

Peroperative Intra-Articular Infiltration of Tranexamic Acid and Ropivacaine Cocktail in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial

“…In our study, the mean duration of hospital stay was 3.82 and 6.30 days, respectively, in groups A and B, and this difference was statistically significant (p < 0.001). This was similar to a study by Pei et al where the average hospital stay was 7.1 days in the group that received intra-articular injection compared to 8.7 days in the control group (p = 0.003) [20]. However, in the series by Parvataneni et al, the mean hospitalization was 3.2 days in both groups receiving a peri-articular injection of 0.5% bupivacaine and the control group, which was found to be statistically insignificant (p > 0.05) [3].…”

“…However, the difference in the mean VAS scores between both knees at 72 hours was not significant statistically (p = 0.097). There was statistically significant lower postoperative VAS score for pain, during the first 48 hours, in studies conducted by Vendittoli et al [11] (p = 0.01), Pei et al [20] (p = 0.001), and Kelly et al [12] (p = 0.023).…”

“…The average age in our study was 64.04 years, and the majority of patients were in the age group of 61 to 65 years. Pei et al and Digas et al reported a mean age of 65.5 years and 70 years, respectively, in their studies on TKA patients [20,15].…”

“…Intra-articular local infiltrations with local anesthetics such as ropivacaine have been shown to reduce initial severe postoperative pain [4,11,12,19]. The use of local antifibrinolytics such as tranexamic acid decreases the need for postoperative blood transfusions [5,13,15,18,20].…”

Different Treatments in Patients with Temporomandibular Joint Disorders: A Comparative Randomized Study

“…On the other hand, intra-articular injections with corticosteroids have also been successfully used for different TMJ conditions, despite their potential adverse effects such as progression of a pre-existing joint lesion [12][13][14][15][16][17]. Corticosteroid therapy is usually combined with a local anesthetic, an association that, although controversial, is believed by certain authors to decrease the risk of complications compared to the isolated administration of corticosteroids [13,[17][18][19].…”