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New Pain Protocol During Total Knee Replacement

Pain after a total knee replacement (TKR) is usually managed with medication. Narcotics and especially patient-controlled analgesia (PCA) are used for many TKR patients.

But a new study shows that using a periarticular injection may be a better choice. Researchers report the results of injecting a cocktail of drugs into the knee during the operation. The cocktail is a mixture of drugs. It includes a numbing agent like Novocaine, antibiotics, morphine, and steroids (antiinflammatory).

The cocktail is injected into the joint capsule just before inserting the joint liner. Another injection goes into the soft tissues around the joint after the implant is in place.

Pain control using this cocktail isn't much different from the PCA. But postoperative function, motion, and patient satisfaction are all much improved. In fact, more patients in the cocktail group went home sooner. They also used fewer narcotic drugs overall.

When re-examined at six weeks and three months after the surgery, there were no differences between the groups. The authors predict future advances in TKR won't be a less invasive operation. It's more likely that the post-operative period will be managed better.

Patients will have better local pain control. Less tissue trauma during the operation and better pain control mean the patients can have a more advanced physical therapy rehab program. With these improvements, patients will be discharged faster and return to full function sooner.

References: Gina Brockenbrough. Greater Patient Satisfaction with New Periarticular TKA Cocktail Injection. IN Orthopedics Today. August 2007. Vol. 27. No. 8. Pp. 6-7.

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