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Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplasty.

Essving P, Axelsson K, Kjellberg J, Wallgren O, Gupta A, Lundin A - Acta Orthop (2009)

Bottom Line: Median hospital stay was shorter in group A than in group P: 1 (1-6) days as opposed to 3 (1-6) days (p < 0.001).Morphine consumption was statistically significantly lower in group A for the first 48 h, resulting in a lower frequency of nausea, pruritus, and sedation.Local injection of analgesics periarticularly at the end of the operation and intraarticularly at 21 h postoperatively provided excellent pain relief and earlier home discharge following UKA.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, University of Linköping, Sweden. per.essving@orebroll.se

ABSTRACT

Background and purpose: The degree of postoperative pain is usually moderate to severe following knee arthroplasty. We investigated the efficacy of local administration of analgesics into the operating area, both intraoperatively and postoperatively.

Methods: 40 patients undergoing unicompartmental knee arthroplasty (UKA) were randomized into 2 groups in a double-blind study (ClinicalTrials.gov identifier: NCT00653926). In group A (active), 200 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine (total volume 106 mL) were infiltrated intraoperatively into the soft tissue, while in group P (placebo), no injections were given. 21 hours postoperatively, 150 mg ropivacain, 30 mg ketorolac, and 0.1 mg epinephrine were injected intraarticularly via a catheter in group A, whereas patients in group P were injected with the same volume of saline (22 mL).

Results: Median hospital stay was shorter in group A than in group P: 1 (1-6) days as opposed to 3 (1-6) days (p < 0.001). Postoperative pain in group A was statistically significantly lower at rest after 6 h and 27 h and on movement after 6, 12, 22, and 27 h. Morphine consumption was statistically significantly lower in group A for the first 48 h, resulting in a lower frequency of nausea, pruritus, and sedation. Postoperatively, there were improved functional scores (Oxford knee score and EQ-5D) in both groups relative to the corresponding preoperative values.

Interpretation: Local injection of analgesics periarticularly at the end of the operation and intraarticularly at 21 h postoperatively provided excellent pain relief and earlier home discharge following UKA. There was a high degree of patient satisfaction in both groups after 6 months (Clinical Trials.gov: NCT 00653926).

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Day 1 represents the first postoperative day. Group A (active)= intraoperative, periarticular infiltration: 200 mg ropivacaine, 30mg ketorolac and 0.5 mg epinephrine; postoperative, intraarticular injection: 150 mg ropivacaine, 30 mg ketorolac and 0.1 mg epinephrine. Group P (placebo)= no intraoperative infiltration and postoperative, intraarticular injection: 22 mL saline. The median discharge times are shown: Group A = day 1 and in Group P = day 3 (p<0.001); Number of patients discharged after 2 days: 17/19 in Group A vs. 6/19 in Group P (p<001).
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Figure 0002: Day 1 represents the first postoperative day. Group A (active)= intraoperative, periarticular infiltration: 200 mg ropivacaine, 30mg ketorolac and 0.5 mg epinephrine; postoperative, intraarticular injection: 150 mg ropivacaine, 30 mg ketorolac and 0.1 mg epinephrine. Group P (placebo)= no intraoperative infiltration and postoperative, intraarticular injection: 22 mL saline. The median discharge times are shown: Group A = day 1 and in Group P = day 3 (p<0.001); Number of patients discharged after 2 days: 17/19 in Group A vs. 6/19 in Group P (p<001).

Mentions: Hospital stay. Analysis of the results when including all 40 patients (intention–to–treat principle) or the 38 patients (per–protocol principle) did not reveal any statistically significant differences. Median postoperative hospital stay was less in group A (n = 19) than in group P (n = 19): 1 (1–6) days vs. 3 (1–6) days (p < 0.001), i.e. there was a median difference of 2 (CI 95% 1–2) days (Figure 2). In group A, 13/19 patients were discharged during the first postoperative day as compared to 2/19 in group P (p < 0.001). During the first 2 postoperative days, 17/19 patients were discharged in group A and only 6/19 were discharged in group P (p < 0.001). 5 patients (2 patients in group A and 3 patients in group P) had a prolonged hospital stay due to pain, and were discharged after the third postoperative day.


Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplasty.

Essving P, Axelsson K, Kjellberg J, Wallgren O, Gupta A, Lundin A - Acta Orthop (2009)

Day 1 represents the first postoperative day. Group A (active)= intraoperative, periarticular infiltration: 200 mg ropivacaine, 30mg ketorolac and 0.5 mg epinephrine; postoperative, intraarticular injection: 150 mg ropivacaine, 30 mg ketorolac and 0.1 mg epinephrine. Group P (placebo)= no intraoperative infiltration and postoperative, intraarticular injection: 22 mL saline. The median discharge times are shown: Group A = day 1 and in Group P = day 3 (p<0.001); Number of patients discharged after 2 days: 17/19 in Group A vs. 6/19 in Group P (p<001).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823175&req=5

Figure 0002: Day 1 represents the first postoperative day. Group A (active)= intraoperative, periarticular infiltration: 200 mg ropivacaine, 30mg ketorolac and 0.5 mg epinephrine; postoperative, intraarticular injection: 150 mg ropivacaine, 30 mg ketorolac and 0.1 mg epinephrine. Group P (placebo)= no intraoperative infiltration and postoperative, intraarticular injection: 22 mL saline. The median discharge times are shown: Group A = day 1 and in Group P = day 3 (p<0.001); Number of patients discharged after 2 days: 17/19 in Group A vs. 6/19 in Group P (p<001).
Mentions: Hospital stay. Analysis of the results when including all 40 patients (intention–to–treat principle) or the 38 patients (per–protocol principle) did not reveal any statistically significant differences. Median postoperative hospital stay was less in group A (n = 19) than in group P (n = 19): 1 (1–6) days vs. 3 (1–6) days (p < 0.001), i.e. there was a median difference of 2 (CI 95% 1–2) days (Figure 2). In group A, 13/19 patients were discharged during the first postoperative day as compared to 2/19 in group P (p < 0.001). During the first 2 postoperative days, 17/19 patients were discharged in group A and only 6/19 were discharged in group P (p < 0.001). 5 patients (2 patients in group A and 3 patients in group P) had a prolonged hospital stay due to pain, and were discharged after the third postoperative day.

Bottom Line: Median hospital stay was shorter in group A than in group P: 1 (1-6) days as opposed to 3 (1-6) days (p < 0.001).Morphine consumption was statistically significantly lower in group A for the first 48 h, resulting in a lower frequency of nausea, pruritus, and sedation.Local injection of analgesics periarticularly at the end of the operation and intraarticularly at 21 h postoperatively provided excellent pain relief and earlier home discharge following UKA.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, University of Linköping, Sweden. per.essving@orebroll.se

ABSTRACT

Background and purpose: The degree of postoperative pain is usually moderate to severe following knee arthroplasty. We investigated the efficacy of local administration of analgesics into the operating area, both intraoperatively and postoperatively.

Methods: 40 patients undergoing unicompartmental knee arthroplasty (UKA) were randomized into 2 groups in a double-blind study (ClinicalTrials.gov identifier: NCT00653926). In group A (active), 200 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine (total volume 106 mL) were infiltrated intraoperatively into the soft tissue, while in group P (placebo), no injections were given. 21 hours postoperatively, 150 mg ropivacain, 30 mg ketorolac, and 0.1 mg epinephrine were injected intraarticularly via a catheter in group A, whereas patients in group P were injected with the same volume of saline (22 mL).

Results: Median hospital stay was shorter in group A than in group P: 1 (1-6) days as opposed to 3 (1-6) days (p < 0.001). Postoperative pain in group A was statistically significantly lower at rest after 6 h and 27 h and on movement after 6, 12, 22, and 27 h. Morphine consumption was statistically significantly lower in group A for the first 48 h, resulting in a lower frequency of nausea, pruritus, and sedation. Postoperatively, there were improved functional scores (Oxford knee score and EQ-5D) in both groups relative to the corresponding preoperative values.

Interpretation: Local injection of analgesics periarticularly at the end of the operation and intraarticularly at 21 h postoperatively provided excellent pain relief and earlier home discharge following UKA. There was a high degree of patient satisfaction in both groups after 6 months (Clinical Trials.gov: NCT 00653926).

Show MeSH
Related in: MedlinePlus