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ORIGINAL ARTICLE
Year : 2020  |  Volume : 12  |  Issue : 2  |  Page : 121-128

A Comparative Study of Pain Control and Early Rehabilitation after Total Knee Replacement: Local Wound Infiltration versus Epidural Bupivacaine in the Immediate Postoperative Period


Department of Orthopaedics, Krishna Institute of Medical Sciences Hospital, Secunderabad, Telangana, India

Correspondence Address:
Dr. M Jonathan Reddy
Department of Orthopaedics, Krishna Institute of Medical Sciences Hospital, Minister Road, Secunderabad - 500 003, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jotr.jotr_21_19

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Aim: To study the efficacy and safety of a periarticular analgesic cocktail injection for early rehabilitation after total knee replacements. Patients and Methods: One hundred patients who are included for TKR were posted for unilateral total knee arthroplasty. This prospective randomized controlled study compared pain relief and functional recovery in immediate postoperative patients (initial 72 h) of total knee replacement where one group of patients are given local analgesia and the other group are given epidural analgesia. The patients were randomized into two arms by block randomization. In one arm, the patients received epidural analgesia for 48 h postoperatively. In the other arm, the patients received periarticular injection of an anesthetic cocktail of drugs. Results: The pain relief on the day of surgery (day 1) was significantly better in patients who received pericapsular injection as compared to those who used the epidural injection for postoperative pain relief. The postoperative range of motion and the distance walked in on the day of suture removal (day 14) was marginally better in the epidural group though the difference was not significant. Side effects including nausea, vomiting, pruritus, urinary retention, and respiratory depression were significantly higher in the epidural group as compared to those who received the analgesic cocktail injection. Conclusion: Patients who received epidural infusion for postoperative pain control required more medications as supplements, as evidenced by higher incidence of bolus injections/increased infusion rates/tramadol injections. There were no surgical site infections in either group.


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