title: Single-dose periarticular steroid infiltration for pain management in total knee arthroplasty: a prospective, double-blind, randomised controlled trial.
abstract: BACKGROUND
  Post total knee replacement pain control using parenteral opioids results in significant side effects like nausea and vomiting. Periarticular injections are used to control pain without these side effects. This study aimed to evaluate the safety and efficacy of periarticular steroid injection in patients undergoing total knee arthroplasty, as well as assess the patient's functional outcomes over a period of two years.
  
  
  METHODS
  A total of 100 patients who underwent total knee arthroplasty were randomised into two groups. The treatment group received periarticular infiltration with triamcinolone acetonide, bupivacaine and epinephrine. The control group received only bupivacaine and epinephrine. The postoperative analgesic regime was standardised for all patients. The immediate postoperative outcomes evaluated included pain score, morphine consumption, time to ambulation, straight leg raise, range of motion and duration of hospital stay. Longer-term outcomes were assessed at 1, 3, 6 and 24 months using the SF-36 questionnaire and Oxford Knee Score.
  
  
  RESULTS
  Patients in the treatment group had significantly lower pain scores, reduced morphine consumption and earlier discharge. They also had better range of knee motion and were able to regain muscular strength earlier. There was no increase in major complications such as infection or tendon rupture in the treatment group. There was no difference between the groups with regard to the medium-term outcomes of up to two years.
  
  
  CONCLUSIONS
  This modality of pain control is safe and efficacious for post total knee replacement pain control.
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
authors.forename: V W T
authors.initials: VW
authors.lastname: Sean
authors.forename: P L
authors.initials: PL
authors.lastname: Chin
authors.forename: S L
authors.initials: SL
authors.lastname: Chia
authors.forename: K Y
authors.initials: KY
authors.lastname: Yang
authors.forename: N N
authors.initials: NN
authors.lastname: Lo
authors.forename: S J
authors.initials: SJ
authors.lastname: Yeo
mesh_terms: D000368:Aged; D000698:Analgesia / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D015992:Body Mass Index; D002045:Bupivacaine / Q000008:administration & dosage; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D006801:Humans; D007267:Injections / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D013256:Steroids / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage
chemical_list: D013256:Steroids; D014222:Triamcinolone Acetonide; D002045:Bupivacaine; D004837:Epinephrine