isepamicin and Pain--Postoperative

Intraoperative local infiltration analgesia has gained increasing popularity in joint replacement surgery. Because there is considerable variation among drug combinations, analgesic effects of each drug are not well understood. The purpose of this study was to clarify the efficacy of the addition of steroid to local anaesthetics in local infiltration analgesia during total knee arthroplasty.. Forty patients were randomly allocated to the steroid or control group. Patients in the steroid group received peri-articular injection of ropivacaine, dexamethasone and isepamicin, while dexamethasone was omitted from the analgesic mixture in the control group. Primary outcome was pain severity at rest using 100 mm visual analogue scale.. Pain severity in the steroid group was lower than control group and there were significant differences between groups at post-operative day 1 and 3. Reduction in post-operative pain was associated with a decrease in serum C-reactive protein and interleukin 6 in drainage fluid. The number of patients who were able to perform straight leg raise within post-operative day 2 was 15/20 in the steroid group, which was significantly higher than the control group 5/20.. Adding steroid to local anaesthetics in local infiltration analgesia reduced inflammation both locally and systemically, resulting in significant early pain relief and rapid recovery in total knee arthroplasty.

Topics: Aged; Amides; Anesthetics, Local; Anti-Bacterial Agents; Anti-Inflammatory Agents; Arthroplasty, Replacement, Knee; C-Reactive Protein; Dexamethasone; Female; Gentamicins; Humans; Injections, Intra-Articular; Interleukin-6; Male; Osteoarthritis, Knee; Pain Management; Pain Measurement; Pain, Postoperative; Ropivacaine; Treatment Outcome

Although intra-operative local infiltration analgesia has gained increasing popularity in joint replacement surgery, it is not clear whether postoperative local infusion analgesia using an indwelling catheter provides clinically important additional effects. We, therefore, conducted a randomized controlled trial to clarify the efficacy of the originally developed local infusion analgesia technique in total knee arthroplasty.. Forty patients were randomly allocated to the local infusion analgesia or control group. Patients in the local infusion analgesia group received intermittent bolus intra-articular injection of analgesics consisting of ropivacaine, dexamethasone, and isepamicin until postoperative 48 h. Primary outcome was pain severity at rest using 100-mm visual analogue scale.. Pain severity in patients of the local infusion analgesia group was lower than control group, and there were significant differences between groups at POD1 (p = 0.025) and POD3 (p = 0.007). Reduction of postoperative pain was associated with a decrease in C-reactive protein level and earlier achievement of straight leg raise. In addition, postoperative drain volume was reduced in the local infusion analgesia group.. Although larger studies are needed to examine its safety, the local infusion analgesia alone provided clinically significant analgesic effects and rapid recovery in total knee arthroplasty.

Topics: Aged; Amides; Analgesics; Anesthetics, Local; Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; C-Reactive Protein; Catheterization; Dexamethasone; Double-Blind Method; Female; Gentamicins; Glucocorticoids; Humans; Infusions, Intraosseous; Male; Middle Aged; Osteoarthritis, Knee; Pain Management; Pain Measurement; Pain, Postoperative; Ropivacaine; Treatment Outcome