Additional pain relieving effect of intraoperative periarticular injections after simultaneous bilateral TKA: a randomized, controlled study

The authors investigated the clinical value of intraoperative periarticular multimodal drug injections (PMDI) in patients on continuous epidural analgesia after simultaneous bilateral TKAs. In 55 patients scheduled to undergo simultaneous bilateral TKAs, one knee was randomly assigned to the PMDI group for which intraoperative periarticular injections were administered and the other knee was assigned to the No-PMDI group for which the injections were not done. These two groups were compared for pain level (during the operation night and on postoperative days (POD) 1, 4, and 7), functional recovery (ability to perform straight leg raising on POD 1 and maximum flexion on POD 7), patient satisfaction (POD 7), and the incidence of wound complications. The PMDI group showed a lower pain level during the operation night and on POD 1 than the No-PMDI group, but no differences in pain levels were observed between the groups on POD 4 or 7. Furthermore, no significant group differences were found in terms of functional recovery, patient satisfaction. No wound complication has been occurred in the PMDI group. This study demonstrates that PMDI provides additional pain relief limited to the immediate postoperative period but does not improve pain relief after POD 1, patient satisfaction and functional recovery.Maheshwari AV, 2009, CLIN ORTHOP RELAT R, V467, P1418, DOI 10.1007/s11999-009-0728-7Johanson NA, 2009, J AM ACAD ORTHOP SUR, V17, P183PARVIZI J, 2009, INSTR COURSE LECT, V58, P769ZENI JA, 2009, J ARTHROPLASTY 0407Hebl JR, 2008, REGION ANESTH PAIN M, V33, P510, DOI 10.1016/j.rapm.2008.04.008Kerr DR, 2008, ACTA ORTHOP, V79, P174, DOI 10.1080/17453670710014950Kim HA, 2008, RHEUMATOLOGY, V47, P88, DOI 10.1093/rheumatology/kem308Ranawat AS, 2007, J ARTHROPLASTY, V22, P12, DOI 10.1016/j.arth.2007.05.040Parvataneni HK, 2007, J ARTHROPLASTY, V22, P33, DOI 10.1016/j.arth.2007.03.034Park KK, 2007, CLIN ORTHOP RELAT R, P143, DOI 10.1097/BLO.0b013e31804ea0bcPARVATANENI HK, 2007, INSTR COURSE LECT, V56, P125Toftdahl K, 2007, ACTA ORTHOP, V78, P172, DOI 10.1080/17453670710013645VISCUSI ER, 2007, INSTR COURSE LECT, V56, P139Peters CL, 2006, J ARTHROPLASTY, V21, P132, DOI 10.1016/j.arth.2006.04.017Powell RS, 2006, J ARTHROPLASTY, V21, P642, DOI 10.1016/j.arth.2005.08.009Busch CA, 2006, J BONE JOINT SURG AM, V88A, P959, DOI 10.2106/JBJS.E.00344Zaric D, 2006, ANESTH ANALG, V102, P1240, DOI 10.1213/01.ane.0000198561.03742.50Vendittoli PA, 2006, J BONE JOINT SURG AM, V88A, P282, DOI 10.2106/JBJS.E.00173Viscusi ER, 2005, ANESTH ANALG, V101, pS23Lombardi AV, 2004, CLIN ORTHOP RELAT R, P125, DOI 10.1097/01.blo.000147701.24029.ccBlock BM, 2003, JAMA-J AM MED ASSOC, V290, P2455SINATRA RS, 2002, J AM ACAD ORTHOP SUR, V10, P117Wheatley RG, 2001, BRIT J ANAESTH, V87, P47Kopacz DJ, 1999, ANESTH ANALG, V89, P1497Trousdale RT, 1999, MAYO CLIN PROC, V74, P978Kampe S, 1999, ANESTH ANALG, V89, P395Cohen RG, 1997, J ARTHROPLASTY, V12, P497Lu HS, 1996, CHINESE MED J-PEKING, V109, P937KIM JM, 1995, CLIN ORTHOP RELAT R, P177WARE JE, 1992, MED CARE, V30, P473MAHONEY OM, 1990, CLIN ORTHOP RELAT R, P30INSALL JN, 1989, CLIN ORTHOP RELAT R, P13BELLAMY N, 1988, J RHEUMATOL, V15, P1833