Knee replacement: early periarticular injection fails to yield advantage

  • Laoruengthana A & al.
  • BMC Musculoskelet Disord
  • 11.04.2019

  • von Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • A randomized controlled trial finds that early is no better than late periarticular multimodal drug injection (PMDI) for pain and functional recovery after bilateral total knee arthroplasty (TKA).

Why this matters

  • Findings do not justify change in standard practice of late timing of PMDI administration.

Study design

  • Randomized, double-blinded, controlled trial (n=48) of early PMDI (immediately after knee arthrotomy) vs late PMDI (before prosthetic implantation).
  • PMDI consists of bupivacaine (100 mg), Ketorolac (30 mg), morphine sulfate (5 mg), and adrenaline (300 μg).
  • Pain at rest (by visual analog scale [VAS]) and most functional recovery measures were assessed at various points up to 6 weeks postoperatively.
  • Funding: None.

Key results

  • No differences between groups in the following:
    • operative duration,
    • drain output (24-48 hours),
    • VAS at rest (6 hours-6 weeks),
    • degrees of knee flexion using continuous passive motion (24-96 hours),
    • degrees of active knee flexion (2-6 weeks),
    • degrees of straight leg raising (48 hours-6 weeks), and
    • degrees of extension (48 hours-6 weeks).

Limitation

  • Small sample sizes.