Objective To study the analgesic effect of a new “cocktail” of local infiltration analgesia (LIA) with Deprosone after total hip arthroplasty (THA). Methods In a prospective randomized controlled study, 100 patients with hip joint disease requiring unilateral primary THA in West China Hospital of Sichuan University between January 2018 and December 2018 were enrolled and randomly divided into observation group and control group, with 50 cases in each group. There was no significant difference in age, gender, operative side, disease type, body mass index, American Society of Anesthesiologists (ASA) classification, preoperative rest and activity visual analogue scale (VAS) score, hip Harris score (HHS), quality of life scale (SF-12) score, and other general data between the two groups (P>0.05). The patients in the observation group were treated with a new “cocktail” LIA around the hip joint before suturing the incision, and the drug formula was ropivacaine 200 mg, Diprospan 1 mL, morphine 10 mg, and added normal saline to 80 mL; the patients in the control group were not treated with LIA. The operation time, postoperative hospital stay, the amount of morphine used during hospitalization, and the range of motion of hip joint at discharge were recorded, and the complications were counted. The VAS score at rest and activity, HHS score, and SF-12 score [physiological score (PCS) and psychological score (MCS)] of the hip joint were recorded before and after operation, and the postoperative analgesic effect and the recovery of hip joint function were evaluated. Results There was no significant difference in the operation time between the two groups (P>0.05), and the postoperative hospital stay in the observation group was significantly shorter than that in the control group (P<0.05). The postoperative morphine consumption in the observation group was significantly less than that in the control group (P<0.05), and the total morphine consumption in the observation group was less than that in the control group during hospitalization, but the difference was not significant (P>0.05). Patients in both groups were followed up to 6 months after operation. The resting VAS scores of the observation group were significantly lower than those of the control group at 2, 6, 12 hours after operation and in the morning and afternoon of the first day after operation, and the active VAS scores of the observation group were significantly lower than those of the control group at 6, 12 hours after operation and in the morning of the first day after operation, and the differences were significant (P<0.05). There was no significant difference in the resting and active VAS scores between the two groups on the day of discharge and at 3 and 6 months after operation (P>0.05). At discharge, the flexion range of motion of hip joint in the observation group was significantly greater than that in the control group (P<0.05), but there was no significant difference in the abduction range of motion of hip joint between the two groups (P>0.05). There was no significant difference in HHS score and SF-12 score between the two groups at 3 and 6 months after operation (P>0.05). There was no significant difference in analgesic satisfaction and functional satisfaction between the two groups at last follow-up (P>0.05). There was no complication such as skin pruritus, superficial and deep infection of incision, skin necrosis, deep venous thrombosis of lower extremity, and pulmonary embolism in both groups. There was no significant difference in the incidence of complications such as nausea and vomiting, urine retention, fat liquefaction of incision, local hematoma, and large fluctuation of blood sugar between the two groups (P>0.05). ConclusionThe new “cocktail” LIA with Diprospan can effectively reduce the early postoperative pain of THA, reduce the dosage of opioids, shorten the length of hospital stay, and is conducive to the early functional rehabilitation of patients.
Objective To review the research progress of injection sites of local infiltration analgesia (LIA) in total knee arthroplasty (TKA). MethodsThe relevant domestic and foreign literature in recent years was extensively reviewed. The neuroanatomy of the knee, and the research progress of the selection and the difference of effectiveness between different injection sites of LIA in clinical studies were summarized. ResultsLarge concentrations of nociceptors are present throughout the various tissues of the knee joint. Patellar tendon, subpatellar fat pad, lateral collateral ligament insertions, iliotibial band insertions, suprapatellar capsule, and posterior capsule were more sensitive to pain. Most current studies support injections into the lateral capsule, collateral ligament, retinaculum, quadriceps tendon, fat pad, and subcutaneous tissue. Whether to inject into the back of the knee and subperiosteum is controversial. ConclusionThe relative difference of knee tissue sensitivity to pain has guiding significance for the selection of LIA injection site after TKA. Although researchers have conducted clinical trials on injection site and technique of LIA in TKA, there are certain limitations. The optimal scheme has not been determined yet, and further studies are needed.
ObjectiveTo evaluate the early effectiveness of local infiltration anesthesia (LIA) with compound betamethasone in total knee arthroplasty (TKA). MethodsThe clinical data of 102 patients with knee osteoarthritis who were treated by TKA and met the selection criteria between May 2022 and March 2023 were retrospectively analyzed. They were divided into control group and study group according to whether LIA preparation was added with compound betamethasone, with 51 cases in each group. There was no significant difference of baseline data, such as age, gender, body mass index, operative side, preoperative range of motion (ROM), Knee Society Score (KSS), white blood cell (WBC), and hematocrit between the two groups (P>0.05). The intraoperative total blood loss and hidden blood loss were recorded, and WBC was recorded on the 1st, 2nd, and 3rd days after operation. Pain was assessed by visual analogue scale (VAS) score on the 1st, 2nd, and 3rd days after operation and morphine intake milligrames equivalent within 48 hours after operation. Passive ROM, maximum extension and flexion angles of knee joint were measured on the 3rd day after operation; the early postoperative complications were recorded. ResultsThere was no significant difference in total blood loss and hidden blood loss between the two groups (P>0.05). The postoperative pain levels in both groups were relatively mild, and there was no significant difference in VAS scores in the first 3 days after operation and in morphine intake milligrams equivalent within 48 hours after operation between the two groups (P>0.05). The WBC in the first 3 days after operation was significantly improved in both groups (P<0.05). The WBC in the study group was significantly higher than that in the control group on the 1st and 2nd days after operation (P<0.05), but there was no significant difference between the two groups on the 3rd day after operation (P>0.05). On the 3rd day after operation, the maximum extension angle of knee joint in the study group was smaller than that in the control group, while the maximum flexion angle and passive ROM of knee joint in the study group were larger than those in the control group, and the differences were significant (P<0.05). There were 6 cases of fever and 17 cases of deep venous thrombosis in the control group, and 1 case and 14 cases in the study group, respectively. There was no poor wound healing and periprosthetic joint infection in the two groups, and there was no significant difference in the incidence of complications between the two groups (P>0.05). ConclusionThe application of compound betamethasone in LIA during TKA is a safe and optimal strategy to promote the early postoperative rehabilitation of patients.
ObjectiveTo summarize the early postoperative pain management strategies for anterior cruciate ligament reconstruction (ACLR), and to select a reasonable and effective pain management plan to promote functional rehabilitation after ACLR. MethodsThe literature about the early postoperative pain management strategies of ACLR both domestically and internationally in recent years was extensiverly reviewed, and the effects of improving postoperative pain were reviewed. ResultsCurrently, physical therapy and oral medication have advantages such as economy and simplicity, but the effect of improving postoperative pain is not satisfactory, often requires a combination of intravenous injection or intravenous pump, which is also a common way to relieve pain. However, in order to meet the analgesic needs of patients, the amount of analgesic drugs used is often large, which increases the incidence of various adverse reactions. Local infiltration analgesia (LIA), including periarticular or intra-articular injection of drugs, can significantly improve the early postoperative pain of ACLR, and achieve similar postoperative effectiveness as nerve block. LIA can be used as an analgesic technique instead of nerve block, and avoid the corresponding weakness of innervated muscles caused by nerve block, which increases the risk of postoperative falls. Many studies have confirmed that LIA can alleviate postoperative early pain in ACLR, especially the analgesic effects of periarticular injection are more satisfactory. It can also avoid the risk of cartilage damage caused by intra-articular injection. However, the postoperative analgesic effect and timeliness still need to be improved. It is possible to consider combining multimodal mixed drug LIA (combined with intra-articular and periarticular) with other pain intervention methods to exert a synergistic effect, in order to avoid the side effects and risks brought by single drugs or single administration route. LIA is expected to become one of the most common methods for relieving postoperative early pain in ACLR. ConclusionEarly pain after arthroscopic ACLR still affects the further functional activities of patients, and all kinds of analgesic methods can achieve certain effectiveness, but there is no unified standard at present, and the advantages and disadvantages of various analgesic methods need further research.