Is Multimodal pain management the new standard of care in total knee replacement?

Abstract

Background: Measures for pain management after total knee arthroplasty (TKA) are important for early improvement in the quality of life after operation and early postoperative rehabilitation. This study was conducted to evaluate whether multimodal drug therapy with periarticular joint injection is better than conventional combined epidural and spinal in total knee arthroplasty (TKA). Methods: 40 patients undergoing TKA for osteoarthritis were divided into two groups. Group A (20 knees; control group), this group underwent surgery under combined spinal and epidural analgesia. While group B (20 knees) underwent surgery under spinal combined with intra-articular injection of multimodal drug cocktail. All analgesics administered post-operatively were recorded. The evaluation of pain was done using visual analogue scale (VAS). Results: The VAS scores on post-operative days 0, 2, 5 were low in group B compared to group A. The usage of analgesics post operatively was high in group A. The level of pain control was higher in group B than in group A. Conclusion: Intraoperative periarticular injection with multimodal drugs can significantly reduce the requirements for patient-controlled analgesia and improve patient satisfaction, with no apparent risks, following total knee arthroplasty.