Comparison of Efficacy of Intra Operative Periarticular Injection With That of Post Operative Epidural Analgesia for Pain Control Following Unilateral Total Knee Arthroplasty Under Spinal Anesthesia — A Prospective Randomized Controlled Trial
Objective: To compare the efficacy of intra operative periarticular injection with that of post operative epidural analgesia for pain control following unilateral total knee arthroplasty under spinal anesthesia with regard to benefits in postoperative pain at rest and during activity and postoperative range of motion. Methods: Eighty patients undergoing TKA by a single surgeon were randomly assigned into two groups with the help of computer generated random numbers. One group received the local periarticular infiltration protocol containing 40 ml of 0.75% of Ropivacaine, 2 ml of ketoralac (30 mg/ml), 0.8 mg Morphine, 0.3 ml of Epinephrine (1:1000) and 16.9 ml of Normal saline. The other group underwent epidural analgesia with infusion pump. Both groups received the same operative procedures and rehabilitation protocol. The results were compared and the variables analyzed were postoperative pain at rest and activity (Visual analogue scale for pain), postoperative complications, range of motion and rescue analgesia.
Results: Periarticular injection was associated with significantly lower early postoperative pain at rest, better range of motion, less need for rescue analgesia and fewer complications.
Conclusion: The analysis of data obtained demonstrated that the periarticular infiltration of analgesic agents is significantly effective for pain control and functional recovery with fewer complications. Hence it may be used as a safe alternative to Epidural injections.