title: Controlling pain after total knee arthroplasty using a multimodal protocol with local periarticular injections.
abstract: BACKGROUND
  Measures for pain management after total knee arthroplasty (TKA) are important for early improvement in the quality of life after operation and early postoperative rehabilitation. We investigated the benefits and safety analgesic effect of locally injected drugs around the total knee prosthesis.
  
  
  METHODS
  60 patients undergoing TKA for osteoarthritis were divided randomly into three groups.Group A (20 knees; control group), this group did not receive multimodal drug cocktailtherapy; group B (21 knees), received intra-articular injection of a multimodal drug cocktail; and group C (19 knees), received localperiarticular injection of a multimodal drug cocktail. All analgesics administered in the first 24 h after surgery were recorded. The evaluation items included assessment of pain using a 100-point visual analogue scale (VAS) after the patients awoke on the day of the operation and on postoperative day 1, the dose of diclofenac sodium suppository, the number of days for acquiring assisted ambulation with a walking cane, and side effects. Assessment of flexion angles was conducted at postoperativeweek 1 and at theconclusion of the study.
  
  
  RESULTS
  The VAS scores on the day of surgery and the amounts of diclofenac sodium used indicated good pain relief in groups B and C; the level of pain control was higher in group C than in group B. No cardiac or central nervous system toxicity was observed.
  
  
  CONCLUSIONS
  Periarticular injection with multimodal drugs can significantly reduce the requirements for analgesia, with no apparent risks, following TKA.
authors.affiliation: Department of Orthopaedic Surgery, Itami City Hospital, 1-100 Koyaike, Itami, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nakai
authors.affiliation: Department of Orthopaedic Surgery, Itami City Hospital, 1-100 Koyaike, Itami, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Tamaki
authors.affiliation: Department of Orthopaedic Surgery, Itami City Hospital, 1-100 Koyaike, Itami, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Orthopaedic Surgery, Itami City Hospital, 1-100 Koyaike, Itami, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Nakai
authors.affiliation: Department of Orthopaedic Surgery, Itami City Hospital, 1-100 Koyaike, Itami, Japan.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Onishi
authors.affiliation: Department of Orthopaedic Surgery, Itami City Hospital, 1-100 Koyaike, Itami, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Hashimoto
keywords: Pain control; Periarticular injection; Total knee arthroplasty