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. 2025;13(4):229-232.
doi: 10.22038/ABJS.2024.82135.3736.

The Role of Periarticular Injections for Postoperative Pain after Total Knee Arthroplasty

E Carlos Rodriguez-Merchan  1
Affiliations

The Role of Periarticular Injections for Postoperative Pain after Total Knee Arthroplasty

E Carlos Rodriguez-Merchan. Arch Bone Jt Surg. 2025.

Abstract

Periarticular multimodal drug injection (PMDI) is better than FNB (femoral nerve block) in pain relief after total knee arthroplasty (TKA). PMDI of bupivacaine [20 mL 0.5% bupivacaine hydrochloride - HCl (100 mg) following implantation plus incisional injection of 10 mL 0.5% bupivacaine HCl (50 mg) before wound closure] is more efficacious than PMDI after implantation. PMDI leads to less postoperative pain than IAI (intraarticular injection) and IAI + PMDI. PMDI of magnesium sulfate and sodium bicarbonate added to a conventional PMDI (ropivacaine, epinephrine, and dexamethasone) prolongs analgesia. No differences exist between gonyautoxin (GTX)2/3 (40 µg GTX 2/3 diluted in 30 mL of sodium chloride 0.9%) and a combination of 300 mg of levobupivacaine, 1 mg of epinephrine, and 60 mg ketorolac diluted in 150 mL of sodium chloride 0.9%.

Keywords: Periarticular multimodal drug injection; Postoperative pain; Total knee arthroplasty.

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Conflict of interest statement

The author has no disclosures to report.

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