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Randomized Controlled Trial
. 2021 Jun 1;16(1):357.
doi: 10.1186/s13018-021-02507-1.

Percutaneous periarticular analgesic injection at one day after simultaneous bilateral total knee arthroplasty: an open-label randomized control trial

Takuya Iseki  1   2 , Sachiyuki Tsukada  3   4 , Motohiro Wakui  3 , Kenji Kurosaka  4 , Shinichi Yoshiya  5 , Toshiya Tachibana  6
Affiliations
Randomized Controlled Trial

Percutaneous periarticular analgesic injection at one day after simultaneous bilateral total knee arthroplasty: an open-label randomized control trial

Takuya Iseki et al. J Orthop Surg Res. .

Abstract

Background: The postoperative pain after total knee arthroplasty (TKA) remains a critical issue. The aim of this study was to assess the clinical effectiveness of percutaneous periarticular injection at 1 day following simultaneous bilateral TKA.

Methods: A total of 88 knees in 44 patients who underwent simultaneous bilateral TKA were randomly assigned to receive a percutaneous periarticular injection at 1 day following surgery (n = 22 patients) or no injection (n = 22 patients). In the additional injection group, we injected a solution including methylprednisolone, ropivacaine, and epinephrine into the muscle belly of the vastus medialis at 1 day after surgery. In both groups, patients received an intraoperative periarticular multi-drug injection and postoperative intravenous and oral nonsteroidal anti-inflammatory drugs. The primary outcome measure was the postoperative pain at rest using a visual analog scale (VAS) and analyzed with Student's t test.

Results: Compared to the no additional injection group, the additional periarticular injection group had significantly lower VAS score at 8:00 PM postoperative day 1, 6:00 AM postoperative day 2, 12:00 PM postoperative day 2, 6:00 AM postoperative day 5, 12:00 PM postoperative day 5, and 8:00 PM postoperative day 5 (p < 0.05). The rate of complication did not differ between groups (p > 0.05).

Conclusion: Additional percutaneous periarticular injection at 1 day following TKA adding to intraoperative periarticular injection provided better postoperative pain relief.

Trial registration: Registered at the University Hospital Medical Information Network (registration number: UMIN000029759 ).

Keywords: Additional injection; Postoperative pain; Randomized; Simultaneous bilateral total knee arthroplasty.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Percutaneous periarticular analgesic injection at 1 day after surgery. (For right knee.) a Inject 6.1 ml of drug solution into muscle belly of the vastus medialis just medial to the quadriceps tendon. b Direct the tip of the needle inward and inject 5 ml of drug solution into the muscle belly of the vastus medialis at a more medial site than the first infiltration.
Fig. 2
Fig. 2
Diagram showing the flow of patients through each stage of the trial
Fig. 3
Fig. 3
Visual analogue scale score of postoperative pain at rest. * p < 0.05
Fig. 4
Fig. 4
Visual analogue scale score of postoperative pain during activity. * p < 0.05
Fig. 5
Fig. 5
Postoperative flexion angle of the knee. * p < 0.05
Fig. 6
Fig. 6
Postoperative extension angle of the knee. * p < 0.05
See this image and copyright information in PMC

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