title: Efficacy of periarticular multimodal drug injection after medial opening-wedge high tibial osteotomy: a randomized, controlled study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the efficacy of periarticular multimodal drug injection after medial opening-wedge high tibial osteotomy regarding the postoperative pain level.
  
  
  METHODS
  From January 2011 to January 2012, 70 patients underwent medial opening-wedge high tibial osteotomy. Thirty-five patients were randomly assigned to receive no injection (group I), and 35 patients were assigned to receive periarticular multimodal drug injection (group II). These 2 groups were compared regarding the postoperative pain level, frequency of additional nonsteroidal anti-inflammatory drug injections, total amount of patient-controlled analgesia, and number of times that patients pushed the patient-controlled analgesia button at each time interval. Statistical results were based on multivariate analysis of variance and repeated-measures analyses.
  
  
  RESULTS
  Multivariate analysis of variance of mean visual analog scale (VAS) scores over the 2-week postoperative period showed statistical significance (P < .001). Repeated-measures analysis yielded a statistically significant difference (P = .001) for the time-by-treatment interaction, showing a clear periarticular multimodal drug injection benefit over time based on VAS scores. In addition, the mean number of times that patients pushed the patient-controlled analgesia button differed significantly between groups over time (P = .01). The VAS scores, frequency of additional nonsteroidal anti-inflammatory drug injections, mean number of times that patients pushed the patient-controlled analgesia button, and mean total amount of fentanyl consumption differed significantly within each group over time (P < .001 for all variables). However, the frequency of additional nonsteroidal anti-inflammatory drug injections and mean total amount of fentanyl consumption did not differ significantly between groups over time (P = .822, P = .529, and P = .282). Opioid- and injection-related complications were not found.
  
  
  CONCLUSIONS
  This prospective randomized study shows that intraoperative periarticular multimodal drug injections in patients undergoing medial opening-wedge high tibial osteotomy for unicompartmental osteoarthritis of the knee could result in significant reductions in VAS scores at 2 weeks postoperatively.
  
  
  METHODS
  Level I, high-quality randomized controlled trial with statistically significant differences.
authors.affiliation: Department of Orthopaedic Surgery, Murup Hospital, Gyeongnam, South Korea.
authors.forename: Woon-Hwa
authors.initials: WH
authors.lastname: Jung
authors.affiliation: Yokosuka Municipal Hospital, Kanagawa, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Takeuchi
authors.affiliation: Department of Orthopaedic Surgery, Murup Hospital, Gyeongnam, South Korea.
authors.forename: Chung-Woo
authors.initials: CW
authors.lastname: Chun
authors.affiliation: Department of Orthopaedic Surgery, Murup Hospital, Gyeongnam, South Korea.
authors.forename: Jung-Su
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Murup Hospital, Gyeongnam, South Korea.
authors.forename: Jae-Hun
authors.initials: JH
authors.lastname: Ha
authors.affiliation: Department of Orthopaedic Surgery, Murup Hospital, Gyeongnam, South Korea.
authors.forename: Ji-Hyae
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Murup Hospital, Gyeongnam, South Korea. Electronic address: osjjaeheon@naver.com.
authors.forename: Jae-Heon
authors.initials: JH
authors.lastname: Jeong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D004338:Drug Combinations; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010027:Osteotomy; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D013977:Tibia / Q000601:surgery
chemical_list: D000700:Analgesics; D004338:Drug Combinations; D012965:Sodium Chloride; D009020:Morphine; D002045:Bupivacaine; D004837:Epinephrine