title: Comparison of 2 Methods of Local Anesthetic-Based Injection as Part of a Multimodal Approach to Pain Management After Total Knee Arthroplasty.
abstract: BACKGROUND
  It is estimated that up to 50% of patients undergoing total knee arthroplasty (TKA) receive suboptimal postoperative pain management.
  
  
  METHODS
  In a retrospective study, 224 patients who underwent TKA between January 1, 2011, and September 30, 2012, were identified by surgical records for 2 surgeons at Community Medical Center in Missoula, Montana. Patient records were reviewed and data collected for patient hospital length of stay (LOS), postoperative opioid use, opioid-associated adverse events, and nonopioid analgesic use. Data were analyzed for differences in outcomes between patients who received an intraoperative intra-articular (IOIA) injection followed by a postoperative infusion (0.25%-0.5% bupivacaine) or an intraoperative periarticular (IOPA) injection (ropivacaine, ketorolac, epinephrine, and clonidine) for sustained analgesia after TKA.
  
  
  RESULTS
  Patients who received an IOPA injection had a statistically significant decrease in hospital LOS (67.0 vs 75.9 hours; P = .027) and postoperative nausea and vomiting (39.3% vs 54.9%; P = .023) when compared to patients who received an IOIA infusion. The incidence of having either oversedation or pruritus did not differ between groups (9.8% vs 9.8%; P = 1.00).
  
  
  CONCLUSIONS
  The use of IOPA injections containing ropivacaine, epinephrine, ketorolac, and clonidine during TKA offered some benefit over IOIA infusions containing 0.25% to 0.5% bupivacaine at our institution.
authors.affiliation: Skaggs School of Pharmacy, University of Montana, Missoula, MT, USA teyatietjepharmd@gmail.com.
authors.forename: Teya
authors.initials: T
authors.lastname: Tietje
authors.affiliation: Pharmacy Department, Community Medical Center, Missoula, MT, USA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Davis
authors.affiliation: Pharmacy Department, Johnson City Medical Center, Johnson City, TN, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Rivey
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003000:Clonidine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004333:Drug Administration Routes; D004359:Drug Therapy, Combination / Q000009:adverse effects; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009009:Montana / Q000453:epidemiology; D059408:Pain Management / Q000379:methods*; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000453:epidemiology; D012189:Retrospective Studies; D000077212:Ropivacaine; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000577:Amides; D000700:Analgesics; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D014662:Vasoconstrictor Agents; D000077212:Ropivacaine; D003000:Clonidine; D002045:Bupivacaine; D004837:Epinephrine; D020910:Ketorolac
keywords: analgesia; intraarticular infusion; multimodal analgesia; periarticular injection; total knee arthroplasty