Efficacy of Multimodal Peri- and Intraarticular Drug Injections in Total Knee Arthroplasty

Asker & Baerum Hospital102 enrolled

Overview

Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain, causing patient discomfort, mobilisation and hospital discharge. The aim of this study is to: 1. Compare analgetic efficacy of to types of local infiltration analgesia in total knee arthroplasty. 2. Compare analgetic efficacy of local infiltration analgesia with continuous epidural analgesia.

Total knee arthroplasty (TKA) is increasingly common in the treatment of knee osteoarthritis. TKA is associated with moderate to severe postoperative pain, causing patient discomfort, mobilisation and hospital discharge. Continuous epidural analgesia is often used for controlling pain after TKA. Recent studies describe a new method for pain control after total knee arthroplasty which consists of local infiltration with local anesthetics and adrenaline. This infiltrations can be combined with ketorolac and/or morphine. The aim of this study is to: 1. Compare analgetic efficacy of to types of local infiltration analgesia in total knee arthroplasty. 2. Compare analgetic efficacy of local infiltration analgesia with continuous epidural analgesia.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Enrollment

102

Conditions

Osteoarthritis of the Knee

Interventions

ropivacaineDRUG

intraoperative and 1. postoperative day

adrenalineDRUG

intraoperative LIA (IV and IA) and continuous EDA

ketorolacDRUG

intraoperative and 1. postoperative day

morphine

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * patients at least 18 years of age * scheduled for elective total knee arthroplasty * ASA I-III * signed written informed consent Exclusion Criteria: * age \< 18 * ASA \> III * moderate or severe cardiac disease, bronchial asthma * allergy against ropivacaine, ketorolac or morphine * analgetic abuse * pregnancy or nursing women * severe psychiatric disease * moderate to severe dementia

Locations (1)

Asker and Baerum Hospital

Rud, Norway

Outcomes

Primary Outcomes

Pain at Rest (VAS)

VAS (pain at rest) 0-100 mm. VAS 0 mm means no pain and VAS 100 mm means maximal pain.

Time frame: 48 hours postoperative

Secondary Outcomes

Opioid Use

Morphine used by patient controlled analgesia. Amount of used morphine during the first 48 hours after surgery were documented in the CRF by the pain nurses.

Time frame: 48 hours postoperative

Time to Readiness for Discharge

Each postoperative day, discharge readiness was assessed by an orthopaedic surgeon, a pain nurse, a ward nurse, and a physiotherapist according to the following criteria: no evidence for surgical complications, VAS pain at rest ≤30 mm which is controlled by oral analgesics, ability to eat and drink, ability to walk with elbow crutches, and ability to climb ≥8 stairs.

Time frame: up to 10 days postoperative

Data from ClinicalTrials.gov

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