The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial

Abstract

Background: As an essential component of multimodal analgesia approaches after total knee arthroplasty (TKA), local infiltration analgesia (LIA) can be classified into peri-articular injection (PAI) and intra-articular injection (IAI) according to administration techniques. Currently, there is no definite answer to the optimal choice between the two techniques. Our study aims to investigate analgesic efficacy and safety of PAI versus IAI in patients receiving simultaneous bilateral TKA. Methods: This randomized controlled trial was conducted from February 2017 and finished in July 2018. Sixty patients eligible for simultaneous bilateral total knee arthroplasty were randomly assigned to receive PAI on one side and IAI on another. Primary outcomes included numerical rating scale (NRS) pain score at rest or during activity at 3 h, 6 h, 12 h, 24 h, 48 h, and 72 h following surgery. Secondary outcomes contained active or passive range of motion (ROM) at 1, 2, and 3 days after surgery, time to perform straight leg raise, wound drainage, operation time, and wound complications. Results: Patients experienced lower NRS pain scores of the knee receiving PAI compared with that with PAI during the first 48 h after surgery. The largest difference of NRS pain score at rest occurred at 48 h (PAI: 0.68, 95%CI[0.37, 0.98]; IAI: 2.63, 95%CI [2.16, 3.09]; P < 0.001); and the largest difference of NRS pain score during activity also took place at 48 h (PAI: 2.46, 95%CI [2.07, 2.85]; IAI: 3.90, 95%CI [3.27, 4.52]; P = 0.001). PAI group had better results of range of motion and time to perform straight leg raise when compared with IAI group. There were no differences in operation time, wound drainage, and wound complication. Conclusion: PAI had the superior performance of pain relief and improvement of range of motion to IAI. Therefore, the administration technique of peri-articular injection is recommended when performing local infiltration analgesia after total knee arthroplasty. Trial registration: The trial was retrospectively registered in the Chinese Clinical Trial Registry as ChiCTR1800020420 on 29th December, 2018.

Simultaneous Bilateral Total Knee Arthroplasty Retrospective Case Control Study: Does Genicular Injection Application Yield a More Effective Pain Control Compared with Periarticular Injection?

“…Cheng KY et al carried out a study during which they administered analgesic cocktails via periarticular injection to one knee and via intraarticular injection to the other knee of patients who underwent bilateral knee arthroplasty in the same session, thus conducting a randomized controlled study (15). In another study, the authors classi ed patients who underwent simultaneous bilateral knee arthroplasty into two groups, injected the PAI solution in a randomized manner to the rear or front compartments, and compared the pain and functional results (16).…”

Comparison of the Effect of Intra-Articular, Periarticular, and Combined Injection of Analgesic on Pain Following Total Knee Arthroplasty

“…A sample size calculation 10 indicated that at least 32 patients would be needed in each group to detect a difference in morphine consumption of at least 2 mg with a power of 95% and type-I error of 5%, assuming that the standard deviation of the morphine consumption in each group would be 2 mg as in a previous study 11 .…”

Comparison of the Effect of Different Local Analgesia Administration Techniques in Total Hip Arthroplasty: A Retrospective Comparative Cohort Study

“…Adequate pain management following THA plays an important role in improving patients' overall satisfaction and enhancing functional recovery [ 1 , 2 ]. Multimodal analgesia for postoperative pain following THA has gained popularity, and one aspect of multimodal analgesia is local infiltration analgesia [ 3 – 5 ]. Administration techniques for local infiltration analgesia can be classified into periarticular injection (PAI) and intra-articular injection (IAI) [ 5 ].…”

“…Multimodal analgesia for postoperative pain following THA has gained popularity, and one aspect of multimodal analgesia is local infiltration analgesia [ 3 – 5 ]. Administration techniques for local infiltration analgesia can be classified into periarticular injection (PAI) and intra-articular injection (IAI) [ 5 ]. Recently, we demonstrated that PAI containing triamcinolone acetonide had analgesic and anti-inflammatory effects following THA and had the potential to accelerate early ambulation and reduce the risk of deep vein thrombosis [ 6 ].…”

“…Recently, we demonstrated that PAI containing triamcinolone acetonide had analgesic and anti-inflammatory effects following THA and had the potential to accelerate early ambulation and reduce the risk of deep vein thrombosis [ 6 ]. There are several reports regarding IAI following THA [ 4 , 7 ], including a comparative report between PAI and IAI following total knee arthroplasty [ 5 ]. However, to the best of our knowledge, there are no comparative studies of PAI versus IAI following THA.…”