Efficacy of multimodal perioperative analgesia protocol with periarticular medication injection and nonsteroidal anti-inflammatory drug use in total knee arthroplasty

Abstract

Background: This research examined multimodal analgesia and the use of nonsteroidal anti‑inflammatory drugs (NSAIDs) for early analgesic effect and rehabilitation after total knee arthroplasty (TKA).

Methods: A total of 110 patients who were scheduled to undergo TKA were randomly divided into two groups, experimental group and control group. The experimental group received a periarticular multimodal drug injection containing 200 mg ropivacaine, 30 mg ketorolac tromethamine, 0.3 mg epinephrine, and 5 mg hexadecadrol during surgery. The control group received an equal volume of normal saline. All the patients received an analgesia pump and moderate NSAIDs. Resting and motion numeric rating scale (NRS) scores, knee joint range of motion, length of postoperative hospital stay, patient satisfaction, total nonsteroidal anti‑inflammatory consumption, and side effects were recorded.

Results: The experimental group exhibited significant improvement in pain NRS scores during rest and exercise several days postoperatively. The range of joint motion was more flexible in the experimental group, and the length of postoperative hospital stay was shorter (9.25 ± 1.99 days vs. 10.44 ± 2.62 days, P < 0.05). Patients in the experimental group consumed fewer NSAIDs (965 mg vs. 1325 mg, P < 0.05) and reported greater satisfaction with the surgery.

Conclusion: Intraoperative periarticular injection with multimodal drugs significantly relieved pain after surgery and reduced the requirements for NSAIDs. This injection also improved patient satisfaction and the range of joint motion with no apparent risks following TKA.

Keywords: Analgesia, arthroplasty, knee, nonsteroidal anti‑inflammatory drugs, pain