A Randomized Double-Blind Prospective Study Comparing the Efficacy of Subperiosteal and Periarticular Injections of a Local Anesthetic for Postoperative Pain Management after Total Knee Arthroplasty

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran/Bone Joint and Related Tissues Research Center, Akhtar

2 Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences,Tehran, Iran

Abstract

Objectives: Total knee arthroplasty (TKA) serves as an effective surgical treatment method for advanced osteoarthritis (OA). Nonetheless, it is associated with postoperative pain that can influence patients’ functional outcome. This study aimed to compare the analgesic effect of subperiosteal and periarticular injection methods of a special local anesthetic in patients who underwent TKA.
Methods: This double-blind prospective clinical study was conducted on patients with advanced knee OA who underwent TKA. Patients were randomly divided into two groups, with a local anesthetic (21 ml) administered either in periarticular (P group) or subperiosteal (S group) forms prior to wound closure. The local anesthetic consisted of lidocaine 2% (15 cc), dexmedetomidine (1 cc), and marcaine 0.5% (5 cc). A study-blinded orthopedic resident recorded postoperative pain levels using a 10-point visual analogue score (VAS) (0 indicating no pain, 10 indicating worst pain) at 6, 12, 24, and 48 hours after surgery.
Results: A total of 40 patients (P and S group; n=20 each), consisting of 10 males (mean age=67.4 years old), were included in this study. The intensity of pain in the S group was significantly lower than in the P group 24 hours after surgery (mean VAS scores in the P group: 4±1 vs. the S group: 3.3±0.7, P=0.024). Furthermore, VAS scores at 6, 12, and 48 hours post-surgery were lower in the S group compared to the P group; however, the difference was not statistically significant (P>0.05).
Conclusion: Our study indicated that subperiosteal injection of lidocaine, dexmedetomidine, and marcaine is more effective than periarticular injection, providing effective postoperative pain management after TKA.
Level of evidence: II

Keywords

Main Subjects

References

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The Archives of Bone and Joint Surgery
Volume 11, Issue 11
November 2023
Pages 704-710

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History

  • Receive Date: 29 May 2023
  • Revise Date: 08 October 2023
  • Accept Date: 23 October 2023

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