LOCAL PERIARTICULAR ANALGESIA IN TOTAL KNEE ARTHROPLASTY

To evaluate the use of infiltration of periarticular analgesic agents intraoperatively in total knee arthroplasty (TKA), with regard to benefits, reduction of pain, opioid consumption, improvement of range of motion and early ambulation.

Methods:

To analyze the benefits of periarticular drug infiltration, the patients submitted to TKA were evaluated, being separated into two groups. One group received the local periarticular infiltration protocol containing 0.5% bupivacaine (400mg/20ml), 1/1000 epinephrine (0.3ml), triamcinolone hexacetonide (20mg/1ml), clonidine (150mcg/1ml) and 20 ml of saline (0.9% SS) and, the other group underwent conventional intravenous analgesia. The results were compared and the variables analyzed were age, sex, BMI, comorbidities, postoperative complications, pain, functional capacity, range of motion, transfusion and rescue opioids for analgesia.

Results:

The mean age of the patients was 68 years and most were female and presented involvement of the left knee. Postoperatively, patients who had received periarticular infiltration showed improvement of pain as well as functional capacity.

Conclusion:

The analysis of data obtained demonstrated that the periarticular infiltration of analgesic agents is significantly effective for pain control and functional recovery.Level of Evidence II, Prospective Comparative Study.

Keywords:
Analgesia; Arthroplasty; Knee; Seepage

Characteristic	Total (n = 59)	Without infiltration (n = 30)	Periarticular injection (n = 29)
Side affected
Right	30.0 (50.8)	16.0 (53.3)	14.0 (48.3)
Left	29.0 (49.0)	14.0 (46.7)	15.0 (51.7)
Comorbidities
High blood pressure (HBP)	30.0 (50.8)	13.0 (43.3)	17.0 (58.6)
Diabetes mellitus	10.0 (16.9)	3.0 (10.0)	7.0 (24.1)
Dyslipidemia	5.0 (8.5)	2.0 (6.7)	3.0 (10.3)
Controlled Chronic Kidney Disease	2.0 (3.4)	1.0 (3.3)	1.0 (3.4)
Previous Stroke	2.0 (3.4)	2.0 (6.7)	0.0 (0.0)
Gastroesophageal Reflux Disease	1.0 (1.7)	1.0 (1.6)	0.0 (0.0)

Visual analog Pain scale	Total (n = 59)	Without infiltration (n = 30)	Periarticular injection (n = 29)	p value
(Mean ± Standard deviation)
Preoperative	7.9 ± 0.8	7.7 ± 0.6	8.1 ± 0.9	0.065
24h Postoperative	4.5 ± 1.2	5.3 ± 0.9	3.7 ± 0.9	< 0.001
48h Postoperative	4.3 ± 1.2	4.8 ± 1.1	3.9 ± 1.2	0.004
Functional Capacity
WOMAC (Mean ± Standard deviation)
Preoperative	28.6 ± 7.1	26.0 ± 5.2	31.2 ± 7.9	0.004
Postoperative (3 months)	47.3 ± 7.0	47.1 ± 6.6	47.4 ± 7.5	0.865
Rescue opioid
24h	150.0 (100.0 - 300.0)	200 (100.0 - 300.0)	150.0 (100.0 - 200.0)	0.123
48h	100 (50.0 - 150.0)	150 (100.0 - 200.0)	50 (0.0 - 100.0)	< 0.001
Complications
Nausea	9.0 (15.3)	6.0 (20.0)	3.0 (10.3)	0.472
Vomiting	5.0 (8.5)	4.0 (13.3)	1.0 (3.4)	0.353
Headache	4.0 (6.8)	4.0 (13.3)	0.0 (0.0)	0.112
Incontinence	2.0 (3.4)	0.0 (0.0)	2.0 (6.9)	0.237
Range of motion
Preoperative (medians, extension - flexion)	0 - 120	0 - 120	0 - 120
Postoperative (medians, extension - flexion)	0 - 100	0 - 100	0 - 110

Visual analog pain scale	Without infiltration (n = 30)	Periarticular injection (n = 29)
(Mean ± Standard deviation)
Preoperative	7,8 ± 0,1 (7,5 - 8,1)	8,1 ± 0,2 (7,7 - 8,4)
24h Postoperative	5,3 ± 0,2 (4,9 - 5,7)	3,7 ± 0,2 (3,3 - 4,1)
48h Postoperative	4,8 ± 0,2 (4,3 - 5,3)	3,7 ± 0,2 (3,3 - 4,3)

ATHA EDITORA Rua: Machado Bittencourt, 190, 4º andar - Vila Mariana - São Paulo Capital - CEP 04044-000, Telefone: 55-11-5087-9502 - São Paulo - SP - Brazil
E-mail: actaortopedicabrasileira@uol.com.br

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[1] Correspondence: Rua Colmar Americano da Costa, 121, Apto. 1404C, Pituba, Salvador, BA, Brazil. davidsad@gmail.com

Bupivacaine 0.5%	400 mg/20ml
Epinephrine 1/1000	1/1000 (0.3ml) 300 Mcg
Triamcinolone hexacetonide	20mg/1ml
Clonidine	150mcg/1ml
Saline solution (0.9%)	20ml