Post-Op Pain and Blood Loss in Total Knee Arthroplasty:
An RCT Using Periarticular Injection with
Diclofenac-Based Multimodal Drugs
Manoon Leownorasate MD*,
Naruepol Ruangsillapanu MD*
Affiliation :
* Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
Objective : To study post-operative pain and blood loss after intraoperative periarticular injection with the multimodal
drugs diclofenac, adrenaline, marcaine (bupivacaine) and morphine in total knee arthroplasty.
Material and Method: A prospective randomized controlled trial of knee osteoarthritis patients age more than 55 years
undergoing total knee arthroplasty at Maharat Nakhon Ratchasima hospital from January 2011 through June 2012 was
performed. A group receiving intra-operative periarticular injections was compared to a control group receiving no injections.
Half of a group of forty-two patients, 2 males and 40 females, average age 67.9 years (range 57-84 years), were randomly
assigned to receive the periarticular injection (the injection group), the others to the control group. Pain was measured by
two methods: visual analog score at 6, 12, 24 and 48 hours post-operation and by patient controlled analgesia (PCA)
measuring the daily amount of intravenous morphine used. The amount of blood loss post operation (in the redivac drain),
degree of knee flexion, time to onset of assisted ambulation, length of hospital stay and any complications were also analyzed.
Results : The mean VAS at 6 and 12 hours post operation of the injection group were 2.67 and 2.48, whereas the values for
the control group were 6.10 and 4.95, respectively (p<0.05). Mean quantities of morphine used by PCA by the injection
group during the first day was 9.43 mg, significantly lower than the 18.81 mg used by the control group. Average blood loss
of the injection group at 263.8 ml was also significantly below the 362.1 ml of the control group (p<0.05). The degree of
knee flexion, time to onset of assist ambulation, length of hospital stay and complications, however, were not significantly
different between the groups.
Conclusion : Multimodal drugs, periarticular injections consisting of diclofenac, adrenaline, Marcaine plus a patient
controled anesthetic machine (PCA) with morphine can significantly reduce post-operative pain and blood loss in total knee
arthroplasty without significant adverse effects.
Keywords : Periarticular injection, Multimodal drugs, Diclofenac, Total knee arthroplasty, Blood loss
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