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- Ahead-of-Print
Comparing Analgesic Effects of Pre-Diluted Ropivacaine Local Infiltration Analgesia (LIA) With Intraoperative IV Parecoxib to a Conventional LIA Cocktail in Total Knee Arthroplasty
摘要
Background: Total knee arthroplasties (TKAs) aim for early return to function mainly limited by pain. Perioperative analgesia includes local infiltration analgesia (LIA). Our center uses an LIA cocktail of ketorolac, adrenaline, and ropivacaine as part of enhanced recovery after surgery (ERAS). This is individually drawn, combined, and diluted, which takes additional time. Pre-diluted ropivacaine pack removes these steps. This study compares if pre-diluted ropivacaine LIA with intraoperative IV parecoxib has comparable analgesia effects to the current LIA cocktail. Methods: Prospective randomized cohort trial of primary TKAs in a tertiary center. Patients with inflammatory arthritis and contraindications to non-steroidal anti-inflammatory drugs (NSAIDs) were excluded. LIA was given at the same stages of surgery and weight adjusted. Patients were given either the full cocktail or LIA ropivacaine with IV parecoxib. Visual analogue scale (VAS) scores were collected from postoperative physiotherapy assessments on day 0/1. Results: Patients had an average length of stay of 1.89 days. A total of 37 patients (19 cocktail and 18 pure ropivacaine) with an average age of 68.2 years. The mean VAS for the cocktail was 2.320 ± 0.930 compared to 4.440 ± 0.940 for pure ropivacaine and significantly different (P = 0.0007). Conclusion: The use of a pre-diluted pack of ropivacaine during TKA, while NSAIDs were administered intravenously, reduced the need for manpower/time to prepare the cocktail. Even though all patients were discharged home, conventional cocktails had significantly better pain scores in the immediate postoperative period. The focus on pain control in the immediate postoperative period tended toward using conventional cocktails. Perioperative analgesia for TKA continues to balance between efficiency and efficacy. It would be prudent to explore whether this would affect patient outcomes beyond the immediate postoperative period.