The Role of Periarticular Injections for Postoperative Pain after Total Knee Arthroplasty

Document Type : In Brief

Author

Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

10.22038/abjs.2024.82135.3736

Abstract

Periarticular multimodal drug injection (PMDI) is better than FNB (femoral nerve block) in pain relief 
after total knee arthroplasty (TKA). PMDI of bupivacaine [20 mL 0.5% bupivacaine hydrochloride - HCl 
(100 mg) following implantation plus incisional injection of 10 mL 0.5% bupivacaine HCl (50 mg) before 
wound closure] is more efficacious than PMDI after implantation. PMDI leads to less postoperative pain 
than IAI (intraarticular injection) and IAI + PMDI. PMDI of magnesium sulfate and sodium bicarbona te 
added to a conventional PMDI (ropivacaine, epinephrine, and dexamethasone) prolongs analgesia. No 
differences exist between gonyautoxin (GTX)2/3 (40 µg GTX 2/3 diluted in 30 mL of sodium chloride 
0.9%) and a combination of 300 mg of levobupivacaine, 1 m g of epinephrine, and 60 mg ketorolac 
diluted in 150 mL of sodium chloride 0.9%.
 Level of evidence: I

Keywords

Main Subjects


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