A Randomized Controlled Trial of Intraarticular Ropivacaine for Pain Management Immediately Following Total Knee Arthroplasty
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Total knee arthroplasty (TKA) is a commonly performed procedure for the treatment of end-stage arthritis of the knee. Pain control following TKA is difficult to manage in some patients. We examined the use of a postoperative intraarticular injection of 100 mL of 0.2% (200 mg) ropivacaine in a double-blind, prospective, placebo-controlled pilot study to evaluate its use as a pain control modality. All patients received general anesthesia. Postoperatively, patients were placed on intravenous patient-controlled analgesia with morphine. The ropivacaine group showed an early trend in lower visual analog scale (VAS) scores when compared with the placebo group. Patients receiving ropivacaine used a similar amount of narcotics compared with the placebo group. Intraarticular ropivacaine used for pain control after TKA demonstrated no statistically significant difference in lowering VAS scores or narcotic usage; therefore, intraarticular ropivacaine as a single modality is not recommended for effective pain management.
Level of evidence
- U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 2006 National Hospital Discharge Survey. Available at: http://www.cdc.gov/nchs/nhds.htm. Accessed Oct 7, 2009.
- Badner NH, Bourne RB, Rorabeck CH, et al. Intra-articular injection of bupivacaine in knee-replacement operations. Results of use for analgesia and for preemptive blockade. J Bone Joint Surg Am. 1996; 78: 734–738.
- Browne C, Copp S, Reden L, et al. Bupivacaine bolus injection versus placebo for pain management following total knee arthroplasty. J Arthroplasty. 2004; 19: 377–380. CrossRef
- Busch CA, Shore BJ, Bhandari R, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am. 2006; 88: 959–963. CrossRef
- Hebl JR, Kopp SL, Ali MH, et al. A comprehensive anesthesia protocol that emphasizes peripheral nerve blockade for total knee and total hip arthroplasty. J Bone Joint Surg Am. 2005; 87 Suppl 2: 63–70. CrossRef
- Ritter MA, Koehler M, Keating EM, et al. Intra-articular morphine and/or bupivacaine after total knee replacement. J Bone Joint Surg Br. 1999; 81: 301–303. CrossRef
- Walker RH, Morris BA, Angulo DL, et al. Postoperative use of continuous passive motion, transcutaneous electrical nerve stimulation, and continuous cooling pad following total knee arthroplasty. J Arthroplasty. 1991; 6: 151–156.
- Pham Dang C, Gautheron E, Guilley J, et al. The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement. Reg Anesth Pain Med. 2005; 30: 128–133. CrossRef
- Chelly JE, Greger J, Gebhard R, et al. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty. 2001; 16: 436–445. CrossRef
- Ben-David B, Schmalenberger K, Chelly JE Analgesia after total knee arthroplasty: Is continuous sciatic blockade needed in addition to continuous femoral blockade? Anesth Analg. 2004; 98: 747–749, table of contents. CrossRef
- Lombardi AV, Jr., Berend KR, Mallory TH, et al. Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res. 2004; 125–130.
- Convery PN, Milligan KR, Quinn P, et al. Efficacy and uptake of ropivacaine and bupivacaine after single intra-articular injection in the knee joint. Br J Anaesth. 2001; 87: 570–576. CrossRef
- Marret E, Gentili M, Bonnet MP, et al. Intra-articular ropivacaine 0.75% and bupivacaine 0.50% for analgesia after arthroscopic knee surgery: A randomized prospective study. Arthroscopy. 2005; 21: 313–316. CrossRef
- Knudsen K, Beckman Suurkula M, Blomberg S, et al. Central nervous and cardiovascular effects of I.V. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997; 78: 507–514.
- Wienzek H, Freise H, Giesler I, et al. Altered blood flow in terminal vessels after local application of ropivacaine and prilocaine. Reg Anesth Pain Med. 2007; 32: 233–239.
- Drug facts and comparisons. 60th edn. St Louis, MO: Lippincott Williams & Wilkins 2006.
- Bianconi M, Ferraro L, Traina GC, et al. Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery. Br J Anaesth. 2003; 91: 830–835. CrossRef
- A Randomized Controlled Trial of Intraarticular Ropivacaine for Pain Management Immediately Following Total Knee Arthroplasty
Volume 6, Issue 2 , pp 155-159
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- total knee arthroplasty
- intraarticular injection
- pain control
- randomized controlled trial
- Author Affiliations
- 1. Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS 116, La Jolla, CA, 92037, USA
- 2. Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Scripps Health, 11025 North Torrey Pines Road, Suite 140, La Jolla, CA, 92037, USA