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

Clinical Orthopaedics and Related Research® volume 471, pages 64–75 (2013)Cite this article

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.

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Acknowledgments

We thank The Knee Society research review committee for the honor of receiving the 2012 Chitranjan Ranawat Award.

Author information

Authors and Affiliations

  1. Anderson Orthopaedic Clinic, 2501 Parkers Lane, Suite 200, Alexandria, VA, 22306, USA

    Nitin Goyal MD

  2. Department of Orthopaedic Surgery, Thomas Jefferson University Hospital & The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA

    James McKenzie BS, Peter F. Sharkey MD, Javad Parvizi MD, William J. Hozack MD & Matthew S. Austin MD

Authors
  1. Nitin Goyal MD
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  2. James McKenzie BS
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  3. Peter F. Sharkey MD
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  4. Javad Parvizi MD
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  5. William J. Hozack MD
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  6. Matthew S. Austin MD
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Corresponding author

Correspondence to William J. Hozack MD.

Additional information

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Appendices

Appendix 1. Pain Management Questionnaire (Day of Surgery)

Appendix 2. Pain Management Questionnaire (~6-week Postoperative Visit)

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Goyal, N., McKenzie, J., Sharkey, P.F. et al. The 2012 Chitranjan Ranawat Award: Intraarticular Analgesia After TKA Reduces Pain: A Randomized, Double-blinded, Placebo-controlled, Prospective Study. Clin Orthop Relat Res 471, 64–75 (2013). https://doi.org/10.1007/s11999-012-2596-9

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  • DOI: https://doi.org/10.1007/s11999-012-2596-9

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