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Efficacy of Periarticular Cocktail Injection in Rheumatoid Patients Undergoing Total Knee Replacement

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A Correction to this article was published on 12 October 2020

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Abstract

Background

Pain control after total knee replacement (TKR) is of primary importance to joint replacement surgeons to achieve good functional outcome post-surgery. This becomes even more challenging when these major procedures are done in immunocompromised patients like rheumatoid arthritis. Good peri-operative analgesia facilitates early rehabilitation, improves patient satisfaction, and reduces the hospital stay. The adverse effects caused by epidural analgesia or parenteral opioids can be avoided by replacing it with an analgesic cocktail locally. Our prospective study was to evaluate the benefits of a periarticular cocktail injection which was given in rheumatoid patients undergoing bilateral TKR in single sitting with respect to pain and knee motion recovery.

Methods

Sixty-four rheumatoid arthritis patients undergoing simultaneous primary total knee replacement were included in the study. A total of 128 knees were randomized either to receive a periarticular intra-operative injection containing ropivacaine, fentanyl, clonidine, cefuroxime and epinephrine (Group A) on one knee and to receive plain ropivacaine (Group B) on the opposite knee. The perioperative and post-operative analgesic regimens were standardized. All patients received the same standard analgesia protocol. Visual analog scores for pain, knee range of motion and quadriceps function were recorded on the day of surgery, first post-operative day, second post-operative day, day of discharge, and 2 weeks and 6 weeks during follow-up. The need for rescue analgesic requirement and adverse effects to the cocktail injection were also noted during the study period.

Results

The patients who received the periarticular cocktail fared better in terms of pain scores and functional recovery. Additional rescue agents used were significantly less at 6 h, at 12 h, and over the first 24 h after the surgery in group A when compared with group B. No cardiac or central nervous system toxicity was observed.

Conclusions

Periarticular cocktail injection significantly reduces the requirements for post-operative analgesia and also improves patient satisfaction, with no apparent risks, following total knee arthroplasty in rheumatoid arthritis.

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Change history

  • 12 October 2020

    The article “Efficacy of Periarticular Cocktail Injection in Rheumatoid Patients Undergoing Total Knee Replacement”, written by Nikhil Joseph Martin, Vinod Padmanabhan and Johny Joseph Pindis, was originally published electronically on the publisher’s internet portal (currently SpringerLink) on 20 August 2020 with open access

Abbreviations

ASA:

American Society of Anesthesiology

BMI:

Body mass index

DOD:

Date of discharge

DOS:

Date of surgery

DVT:

Deep vein thrombosis

EL:

Extensor lag

FIG:

Figure

GFR:

Glomerular filtration rate

HbA1C:

Glycosylated hemoglobin

IV:

Intra-venous

IM:

Intra-muscular

KSS:

Knee Society Score

PAI:

Periarticular injection

POD:

Post-operative day

Post-op:

Post-operative

Pre-op:

Preoperative

RA:

Rheumatoid arthritis

ROM:

Range of motion

SLR:

Straight leg raise

TKR:

Total knee replacement

VAS:

Visual analog score

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Sree Sudheendra Medical Mission Hospital, Chittoor Road, Cochin, Kerala, India

    Nikhil Joseph Martin, Vinod Padmanabhan & Johny Joseph Pindis

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  1. Nikhil Joseph Martin
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  2. Vinod Padmanabhan
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  3. Johny Joseph Pindis
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Contributions

Dr Nikhil Joseph Martin (NJM): study concept and design, data collection, data analysis and writing the paper. Dr Vinod Padmanabhan (VP): study concept and design, operating surgeon and writing the paper. Dr Johny Joseph Pindis (JJP): study concept and design, reviewing the paper. The authors thank Ms. Sowbhaghya S Prabhu for her help in preparing the data analysis in this study. The authors thank Dr. Ammu S Bhaskar for her contributions in preparing the manuscript. The authors thank all the staff and management of Sudheendra Medical Mission Hospital for completing the study.

Corresponding author

Correspondence to Nikhil Joseph Martin.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard statement

The study was approved by the institutional review board (IRB) on 11/03/2016 with certificate number (IEC/2016/002B). This study is registered under Institutional Ethics Committee ECR/884/Inst/KL/2016; Sree Sudheendra Medical Mission Hospital, Chittoor road, Cochin, 682018; Kerala, India. Ethical committee Approval: 11/03/2016. Certificate Number: IEC/2016/002B.

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Informed written consent for the publication of clinical details, according to the declaration of Helsinki was taken from the patients.

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The original version of this article was revised due to a retrospective Open Access cancellation.

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Martin, N.J., Padmanabhan, V. & Pindis, J.J. Efficacy of Periarticular Cocktail Injection in Rheumatoid Patients Undergoing Total Knee Replacement. JOIO 54, 811–822 (2020). https://doi.org/10.1007/s43465-020-00230-3

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