How Effective Is Intrawound periarticular Cocktail Injection and Postoperative Intravenous Paracetamol for Analgesia and Early Mobilization after Total Knee Arthroplasty (TKA)
Year: 2023
Type: article
Abstract: Introduction: Total knee arthroplasty (replacement) is a treatment of choice in severe osteoarthritis of knee joint and relieve knee pain and improves joint function, but still managing post-surgical pain after Total knee replacement (TKR) is a challenging and crucial step for early rehabilitation of patient and for better outcome.There are some reports demonstrate the 70 to 75% patients of total knee replacement complaint of moderate to severe chronic pain.Clinical practice guidelines recommend multimodal, therapy combining preoperative, intraoperative, and postoperative medications, such as opioids, nonsteroidal anti inflammatory drugs, gabapentin, pregabalin, and local anesthetics.Adequate pain relief is essential for early mobilization and good functional recovery.Use of intravenous acetaminophen has seen recent enthusiasm as one component of a multimodal approach to pain management.However, there is a lack of literature examining the efficacy of intravenous acetaminophen for pain control in total knee replacement.Aims: The purpose of this study was to evaluate the efficacy of intravenous acetaminophen with intraarticular cocktail injection as multimodal approach for pain management and its effect on early rehabilitation following total knee replacement.Material and Methods: Total (n = 82) patent enrolled in the study who underwent total knee replacement.They were divided into two groups, Group A received epidural analgesia with intravenous (I.V) diclofenac and for any breakthrough pain Tramadol injection was given intravenously.Group B received periarticular injection of an anesthetic cocktail of drugs with antibiotic with intravenous acetaminophen (paracetamol) with diclofenac injection.Inclusion criteria was patient with age group of 50-80 years and underwent unilateral TKR.For outcome Knee society score (KSS) and Visual Analog scale (VAS) was used.For functional outcome Post-operative range of movement was also noted.Results: The mean average KSS score of the study subjects were 52.Group A with epidural analgesic had a score of 58 when compared to 79 for group B where cocktail and IV acetaminophen was used.The mean average functional score was 61 for group A and 75 for group B. Both the scores were better in the analgesic cocktail group B. The mean pain score in group A was 5.2 and in group B was 2.1. Conclusion:In Conclusion periarticular cocktail with Intravenous acetaminophen is effective in significantly reducing opioid/ NSAID's requirements in the first 24 hours following primary total knee arthroplasty.Additionally, there is a clinically significant decrease in VAS pain scores in patients receiving this intervention.
Source: Acta Scientific Orthopaedics
Institution: Adani Group (India)
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4382864552