Comparative study between Ropivacaine and bupivacaine in cocktail periarticular injection, in immediate post-operative analgesia and rehabilitation in patients undergoing total knee arthroplasty (TKA)

Abstract

Background: Total knee arthroplasty (TKA) is associated with moderate to severe post-operative pain in approximately 20-30% of patients despite oral and parenteral analgesic use. A novel approach to pain management is to control local pain pathways and receptors within the knee. A safe and cost effective measure of achieving this is by local intra and periarticular injections of cocktail anesthesia. Objective: To compare the efficacy of ropivacaine and bupivacaine in cocktail periarticular injection, in immediate post-operative analgesia and rehabilitation in patients undergoing total knee arthroplasty.Materials and methods: A total of 46 patients undergoing total knee arthroplasty was divided into two groups. Group I received bupivacaine based cocktail regimen and group II received ropivacaine based cocktail regimen. In the post-operative period, both the groups were compared for pain relief and range of knee movements at 12 and 24 hours respectively. Results: In group I, the mean VAS at 12 hours was 8.01±0.38 and at 24 hours was 3.93±1.95 while in group II, the mean VAS at 12 hours was 7.12±0.47 and at 24 hours was 2.09±0.06. Paried ‘t’ test show statistical significant difference in pain relief among both the groups (p< 0.05). Among our study population, the mean range of movements improved in group II with significant statistical difference of p< 0.001 p=0.03. Conclusion: In patients with TKA, Ropivacaine based cocktail regimen has better post-operative pain relief and earlier range of knee movements while comparing with bupivacaine based cocktail regimen.