Journal of Orthopedics and Joint Surgery

Register      Login

VOLUME 2 , ISSUE 1 ( January-June, 2020 ) > List of Articles


Effectiveness of Pain Control Regimen with Local Infiltrative Analgesia for Total Knee Replacement: A Prospective, Double-blind, Randomized Controlled Trial

Kandasamy Velmurugan, Muthu Sathish, Annamalai Saravanan

Citation Information : Velmurugan K, Sathish M, Saravanan A. Effectiveness of Pain Control Regimen with Local Infiltrative Analgesia for Total Knee Replacement: A Prospective, Double-blind, Randomized Controlled Trial. 2020; 2 (1):22-25.

DOI: 10.5005/jp-journals-10079-1010

License: CC BY-NC 4.0

Published Online: 17-10-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Introduction: Postoperative pain relief in total knee replacement remains a major determinant in the duration of the hospital stay and return to daily activities. Nowadays, a great attention has been given to pain management in the perioperative period focusing on faster recovery. Various analgesic regimens have been in use. The aim of this study is to evaluate the efficacy of our pain control regimen along with the use of local infiltration analgesia (LIA) in terms of postoperative pain control. Materials and methods: A total of 50 patients were included in the study, and they were randomized into study group and control group by computerized randomization, and the study group was followed up with the multimodal pain relief protocol, while the control group was given a placebo; the results were measured with preoperative and postoperative visual analog score (VAS) and results were analyzed. Results: Visual analog score showed a drastic fall of average 4.36 scale parameters compared with the preoperative in the study group and a significant difference of 1.88 on VAS scale compared with postoperative score of the control group. The mean postoperative score was 3.88 in a scale of 10 in the study group, while it remained 5.76 in the control group. Conclusion: Our pain management protocol using effective LIA along with the pain control regimen has revolutionized postoperative recovery. Pain control and patient satisfaction were extremely high. The average length of hospital stay has been reduced to 2.12 days with the implementation of this regimen, with most of them discharged within 24 hours and all of them by second day.

  1. Dalury DF, Lieberman JR, MacDonald SJ. Current and innovative pain management techniques in total knee arthroplasty. J Bone Joint Surg Am 2011;93(20):1938–1943. DOI: 10.2106/JBJS.9320icl.
  2. Busch CA, Shore BJ, Bhandari R, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 2006;88(5):959–963. DOI: 10.2106/00004623-200605000-00005.
  3. Hebl JR, Kopp SL, Ali MH, et al. A comprehensive anesthesia protocol that emphasizes peripheral nerve blockade for total knee and total hip arthroplasty. J Bone Joint Surg Am 2005;87(Suppl 2):63–70. DOI: 10.2106/JBJS.E.00491.
  4. Sharma S, Iorio R, Specht LM, et al. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop 2010;468(1):135. DOI: 10.1007/s11999-009-1025-1.
  5. Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 2008;79(2):174–183. DOI: 10.1080/17453670710014950.
  6. Maheshwari AV, Blum YC, Shekhar L, et al. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop 2009;467(6):1418–1423. DOI: 10.1007/s11999-009-0728-7.
  7. Mullaji A, Kanna R, Shetty GM, et al. Efficacy of periarticular injection of bupivacaine, fentanyl, and methylprednisolone in total knee arthroplasty: a prospective, randomized trial. J Arthroplasty 2010;25(6):851–857. DOI: 10.1016/j.arth.2009.09.007.
  8. Parvataneni HK, Shah VP, Howard H, et al. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections. A prospective randomized study. J Arthroplasty 2007;22(6 Suppl 2):33–38. DOI: 10.1016/j.arth.2007.03.034.
  9. Vendittoli PA, Makinen P, Drolet P, et al. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 2006;88(2):282–289. DOI: 10.2106/JBJS.E.00173.
  10. Ashraf A, Raut VV, Canty SJ, et al. Pain control after primary total knee replacement. A prospective randomised controlled trial of local infiltration versus single shot femoral nerve block. Knee 2013;20(5):324–327. DOI: 10.1016/j.knee.2013.04.009.
  11. Kurosaka K, Tsukada S, Seino D, et al. Local infiltration analgesia versus continuous femoral nerve block in pain relief after total knee arthroplasty: a randomized controlled trial. J Arthroplasty 2016;31(4):913–917. DOI:
  12. Spangehl MJ, Clarke HD, Hentz JG, et al. The Chitranjan Ranawat award: periarticular injections and femoral & sciatic blocks provide similar pain relief after TKA: a randomized clinical trial. Clin Orthop 2015;473(1):45–53. DOI: 10.1007/s11999-014-3603-0.
  13. Tsukada S, Wakui M, Hoshino A. Postoperative epidural analgesia compared with intraoperative periarticular injection for pain control following total knee arthroplasty under spinal anesthesia: a randomized controlled trial. J Bone Joint Surg Am 2014;96(17): 1433–1438. DOI: 10.2106/JBJS.M.01098.
  14. Kelley TC, Adams MJ, Mulliken BD, et al. Efficacy of multimodal perioperative analgesia protocol with periarticular medication injection in total knee arthroplasty: a randomized, double-blinded study. J Arthroplasty 2013;28(8):1274–1277. DOI: 10.1016/j.arth.2013.03.008.
  15. Kingsly P, Sathish M, Ismail NMDM. Analysis of efficacy of tranexamic acid in reduction of blood loss and postoperative blood transfusions following orthopedic trauma surgery. J Orth Joint Surg 2019;1(1): 27–30.
  16. Gillette BP, Maradit Kremers H, Duncan CM, et al. Economic impact of tranexamic acid in healthy patients undergoing primary total hip and knee arthroplasty. J Arthroplasty 2013;28(8 Suppl):137–139. DOI: 10.1016/j.arth.2013.04.054.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.