Clinical Orthopaedics and Related Research®

, Volume 471, Issue 1, pp 64–75

The 2012 Chitranjan Ranawat Award: Intraarticular Analgesia After TKA Reduces Pain: A Randomized, Double-blinded, Placebo-controlled, Prospective Study

  • Nitin Goyal
  • James McKenzie
  • Peter F. Sharkey
  • Javad Parvizi
  • William J. Hozack
  • Matthew S. Austin
Symposium: Papers Presented at the Annual Meetings of the Knee Society

DOI: 10.1007/s11999-012-2596-9

Cite this article as:
Goyal, N., McKenzie, J., Sharkey, P.F. et al. Clin Orthop Relat Res (2013) 471: 64. doi:10.1007/s11999-012-2596-9

Abstract

Background

Postoperative pain after total knee arthroplasty remains one of the most important challenges facing patients undergoing this surgery. Providing a balance of adequate analgesia while limiting the functional impact of regional anesthesia and minimizing opioid side effects is critical to minimize adverse events and improve patient satisfaction.

Questions/Purposes

We asked whether bupivacaine delivered through an elastomeric device decreases the (1) patients’ perception of pain after TKA; (2) narcotic consumption; and (3) narcotic-related side effects as compared with a placebo.

Methods

In this prospective, double-blind, placebo-controlled study, all patients received standardized regional anesthesia, a preemptive and multimodal analgesic protocol, and a continuous intraarticular infusion at 5 mL/hour through an elastomeric infusion pump. The patients were randomized to receive either an infusion pump filled with (1) 300 mL of 0.5% bupivacaine, the experimental group (n = 75); or (2) 300 mL of 0.9% normal saline solution, the control group (n = 75). Data concerning postoperative pain levels through a visual analog scale, postoperative opioid consumption, opioid-related side effects, and complications were collected and analyzed.

Results

Patients in the experimental group receiving the bupivacaine reported a reduction in pain levels in highest, lowest, and current visual analog scale scores compared with the placebo group on the first postoperative day and highest visual analog scale score on postoperative Day 2 along with a 33% reduction in opioid consumption on postoperative Day 2 and a 54% reduction on postoperative Day 3.

Conclusion

In patients undergoing TKA, continuous intraarticular analgesia provided an effective adjunct for pain relief in the immediate postoperative period without the disadvantages encountered with other analgesic methods.

Level of Evidence

Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Nitin Goyal
    • 1
  • James McKenzie
    • 2
  • Peter F. Sharkey
    • 2
  • Javad Parvizi
    • 2
  • William J. Hozack
    • 2
  • Matthew S. Austin
    • 2
  1. 1.Anderson Orthopaedic ClinicAlexandriaUSA
  2. 2.Department of Orthopaedic SurgeryThomas Jefferson University Hospital & The Rothman InstitutePhiladelphiaUSA

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