Comparative evaluation of periarticular infiltration of two cocktail regimens for analgesia in post-operative patients of total knee replacement

Abstract

Abstract Purpose To compare the efficacy of two periarticular cocktail regimens for analgesia in postoperative patients of total knee replacement. Method This is a Randomized Control study done over the duration of 1.5 years. Twenty-five knees of either gender were selected with inclusion criteria (All osteoarthritis patients planned for TKA) and exclusion criteria (Inflammatory arthritis, patients allergic to local anaesthetic e.g. Ropivacaine, bupivacaine, known cardiac disorder patient having AV block, arrhythmia) & divided into 2 groups. Group A was given a cocktail of Ropivacaine, adrenaline, clonidine & cefuroxime. Group B was given a cocktail of bupivacaine, fentanyl, methylprednisolone & cefuroxime. The preoperative pain of the patient was assessed using VAS score. Combined spinal and epidural anaesthesia was given using 0.5% 2\u202fml of bupivacaine heavy in all patients. After taking bone cuts & before the placement of the implant, cocktail of the drug was infiltrated using sterile technique into 9 specific sites. The amount of drug infiltrated was calculated according to the weight of the patient. The patients were assessed on: Pain relief postoperatively at specific duration using VAS score. The amount & frequency of epidural top-ups required. Knee ROM, Quadriceps strength, Extensor lag & Knee society score were assessed. Results Out of the total 25 knees included in the study, 12 belonged to Group A and 13 belonged to Group B. It was observed that 4 (33%) out of 12 Group A patient needed injection tramadol for 2–3 days and fentanyl patch 25mcg. In Group B, one (8%) out of 13 patients required injection tramadol and fentanyl dermal patch for 2–3 days. The difference in additionally required analgesic between patients of the two groups is statistically significant. VAS Score The VAS score of Group B was statistically lower than Group A patients till first 24\u202fh postoperatively. The extension lag was lower in group B compared to group A at 24\u202fh after the surgery and up to 5 days. Overall after 6 weeks of follow-up, the extensor lag between the groups was not statistically significant. Average KSS in group A was 79.58 and in the group, B was 83.99 and the difference in KSS between patients of the two groups was statistically significant. Conclusion Both the cocktail regimens are effective in pain control postoperatively. The relief in pain with regimen B containing bupivacaine, fentanyl, methylprednisolone and cefuroxime was more striking in the first 24\u202fh. By the end of two days, both regimens were found to be equally effective.