Effect of Additioning of Triamcinolon to Cocktail of Fentanil Epinephrinated Bupivacaine in Periarticular Injection for Post Operative Pain and Quality Improvement after Total Knee Arthroplasty

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Anesthesia, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Assistant Professor, Department of Anesthesia, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Department of Orthopedia, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Resident, Department of Anesthesia, School of Medicine And Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Today, total knee arthroplasty surgery is on the rise in the world. One of the characteristics of this surgery is severe post operative pain. The aim of this study was to evaluate the effect of priarticular injection of Triamcinolon on post operative pain and the function of replaced knee after total knee arthroplasty.Methods: This clinical trial was performed on 64 patients 20 to 80 years undergoing to elective knee arthroplasty surgery. Patients were randomized into two groups (32 patients in each groups). The study group received periarticular injection of triamcinolone acetonide, fentanil, bupivacaine and epinephrine. The control group received only fentanil, bupivacaine, epinephrine and normal saline. Periarticular injection was done by surgeon. The amount of pain, using verbal rating scale (VRS) during recovery, 6, 12, 24 and 48 hours after surgery and articular function (by knee society knee score) were assessed as initial outcomes. The collected data was analyzed by SPSS version 18 by using student t-test and Man-Whitney test.Findings: This clinical trial was performed on 64 patients 20 to 80 years undergoing to elective knee arthroplasty Findings: There were not any significant difference in mean of pain score between two groups in recovery, 6, 12 and 24 hours after surgery (P > 0.05). The mean of pain score in 48 hours after surgery was significantly less in study group (P < 0.05). Morphine consumption after 48 hours was significantly less in study group (P = 0.0001). There is a significant different in articular function (range of motion and walking) between two group base on knee society knee score. There was a greater satisfaction in the study group than control group (P = 0.04).Conclusion: These results shown that the use of periarticular triamcinolon can reduced acute and long term post operative pain and improved articular function and long term good sense in patients.

Keywords

References

  1. Badner NH, Bourne RB, Rorabeck CH, MacDonald SJ, Doyle JA. Intra-articular injection of bupivacaine in knee-replacement operations. Results of use for analgesia and for preemptive blockade. J Bone Joint Surg Am 1996; 78(5): 734-8.
  2. Browne C, Copp S, Reden L, Pulido P, Colwell C, Jr. Bupivacaine bolus injection versus placebo for pain management following total knee arthroplasty. J Arthroplasty 2004; 19(3): 377-80.
  3. Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 2006; 88(5): 959-63.
  4. Rasmussen S, Kramhoft MU, Sperling KP, Pedersen JH. Increased flexion and reduced hospital stay with continuous intraarticular morphine and ropivacaine after primary total knee replacement: open intervention study of efficacy and safety in 154 patients. Acta Orthop Scand 2004; 75(5): 606-9.
  5. Parvataneni HK, Ranawat AS, Ranawat CS. The use of local periarticular injections in the management of postoperative pain after total hip and knee replacement: a multimodal approach. Instr Course Lect 2007; 56: 125-31.
  6. Lombardi AV, Jr., Berend KR, Mallory TH, Dodds KL, Adams JB. Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res 2004; (428): 125-30.
  7. Ritter MA, Koehler M, Keating EM, Faris PM, Meding JB. Intra-articular morphine and/or bupivacaine after total knee replacement. J Bone Joint Surg Br 1999; 81(2): 301-3.
  8. Vendittoli PA, Makinen P, Drolet P, Lavigne M, Fallaha M, Guertin MC, et al. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 2006; 88(2): 282-9.
  9. Mauerhan DR, Campbell M, Miller JS, Mokris JG, Gregory A, Kiebzak GM. Intra-articular morphine and/or bupivacaine in the management of pain after total knee arthroplasty. J Arthroplasty 1997; 12(5): 546-52.
  10. Badner NH, Bourne RB, Rorabeck CH, Doyle JA. Addition of morphine to intra-articular bupivacaine does not improve analgesia following knee joint replacement. Reg Anesth 1997; 22(4): 347-50.
  11. Klasen JA, Opitz SA, Melzer C, Thiel A, Hempelmann G. Intraarticular, epidural, and intravenous analgesia after total knee arthroplasty. Acta Anaesthesiol Scand 1999; 43(10): 1021-6.
  12. Mullaji A, Kanna R, Shetty GM, Chavda V, Singh DP. Efficacy of periarticular injection of bupivacaine, fentanyl, and methylprednisolone in total knee arthroplasty:a prospective, randomized trial. J Arthroplasty 2010; 25(6): 851-7.
  13. Fu P, Wu Y, Wu H, Li X, Qian Q, Zhu Y. Efficacy of intra-articular cocktail analgesic injection in total knee arthroplasty-a randomized controlled trial. Knee 2009; 16(4): 280-4.
  14. Pang HN, Lo NN, Yang KY, Chong HC, Yeo SJ. Peri-articular steroid injection improves the outcome after unicondylar knee replacement: a prospective, randomised controlled trial with a two-year follow-up. J Bone Joint Surg Br 2008; 90(6): 738-44.
Journal of Isfahan Medical School
Volume 29, Issue 144 - Serial Number 144
May and June 2011
Pages 791-797

Files

History

  • Receive Date: 18 June 2011
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics