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

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