A comparison of intraoperative epidural analgesia and intraoperative periarticular injection on pain control in total knee arthroplasty

Abstract

Objectives: Multi-modal analgesia is achieved by the combined use of analgesic agents acting on different parts of the pain pathway. This study aims to compare the effects of epidural analgesia and periarticular injection on postoperative pain for 48 hours following total knee arthroplasty (TKA) and on the early functional outcomes. Design: Single-center, prospective, randomized-controlled, and double-blind study Setting: Health Sciences University, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey Subjects: Patients who underwent unilateral TKA were included the study. Intervention(s): The patients were divided into two groups: epidural morphine (Group E) and periarticular injection including 100 mL cocktail solutions (bupivacaine, adrenaline, dexmedetomidine, magnesium sulphate, methylprednisolone, morphine and normal saline) (Group P). Main outcome measure(s): Our primary outcomes were visual analogue scale (VAS) pain scores, dynamic visual analogue scale (DVAS) pain scores, and consumption of analgesics. Secondary outcomes were maximum range of motion (ROM) and side effects. Results: A total of 24 and 27 patients were analyzed in Group P and Group E, respectively. Group P had significantly lower VAS and DVAS scores within the first 48 hours, lower amount of consumed analgesics at 24 and 48 hours, higher ROM values on days 2 and 3, and more severe nausea, vomiting and itching at 12 and 24 hours. Conclusion: Our study results show that periarticular injection with multi-modal drugs in TKA is superior to epidural analgesia with lower VAS-DVAS scores, less analgesic consumption, fewer side effects and improved ROM.