Gonyautoxins: First evidence in pain management in total knee arthroplasty.
Improvements in pain management techniques in the last decade have had a major impact on the practice of total knee arthroplasty (TKA). Gonyautoxin are phycotoxins, whose molecular mechanism of action is a reversible block of the voltage-gated sodium channels at the axonal level, impeding nerve impulse propagation. This study was designed to evaluate the clinical efficacy of Gonyautoxin infiltration, as a long acting pain blocker in TKA. Fifteen patients received a total dose of 40 μg of Gonyautoxin during the TKA operation. Postoperatively, all patients were given a standard painkiller protocol: 100 mg of intravenous ketoprofen and 1000 mg of oral acetaminophen every 8 hours for 3 days. The Visual Analog Scale (VAS) pain score and range of motion were recorded 12, 36, and 60 hours post-surgery. All patients reported pain of 2 or less on the VAS 12 and 36 hours post-surgery. Moreover, all scored were less than 4 at 60 hours post-surgery. All patients achieved full knee extension at all times. No side effects or adverse reactions to Gonyautoxin were detected in the follow-up period. The median hospital stay was 3 days. For the first time, this study has shown the effect of blocking the neuronal transmission of pain by locally infiltrating Gonyautoxin during TKA. All patients successfully responded to the pain control. The Gonyautoxin infiltration was safe and effective, and patients experienced pain relief without the use of opioids.
Department of Orthopedic Surgery, University of Chile Clinical Hospital, Santos Dumont 999, Independencia, Santiago, 8380456, Chile.
Jaime
J
Hinzpeter
Department of Orthopedic Surgery, University of Chile Clinical Hospital, Santos Dumont 999, Independencia, Santiago, 8380456, Chile.
Cristián
C
Barrientos
Department of Orthopedic Surgery, University of Chile Clinical Hospital, Santos Dumont 999, Independencia, Santiago, 8380456, Chile.
Álvaro
Á
Zamorano
Department of Orthopedic Surgery, Hospital San José, San José 1196, Independencia, Santiago, 8380419, Chile.
Álvaro
Á
Martinez
Department of Orthopedic Surgery, University of Chile Clinical Hospital, Santos Dumont 999, Independencia, Santiago, 8380456, Chile.
Miguel
M
Palet
Department of Orthopedic Surgery, University of Chile Clinical Hospital, Santos Dumont 999, Independencia, Santiago, 8380456, Chile.
Rodrigo
R
Wulf
Department of Orthopedic Surgery, University of Chile Clinical Hospital, Santos Dumont 999, Independencia, Santiago, 8380456, Chile.
Maximiliano
M
Barahona
Membrane Biochemistry Laboratory, Department of Physiology and Biophysics, Faculty of Medicine, University of Chile, Independencia 1027, Santiago, 8389100, Chile.
Joaquín M
JM
Sepúlveda
Membrane Biochemistry Laboratory, Department of Physiology and Biophysics, Faculty of Medicine, University of Chile, Independencia 1027, Santiago, 8389100, Chile.
Matias
M
Guerra
Membrane Biochemistry Laboratory, Department of Physiology and Biophysics, Faculty of Medicine, University of Chile, Independencia 1027, Santiago, 8389100, Chile.
Tamara
T
Bustamante
Membrane Biochemistry Laboratory, Department of Physiology and Biophysics, Faculty of Medicine, University of Chile, Independencia 1027, Santiago, 8389100, Chile.
Miguel
M
Del Campo
Membrane Biochemistry Laboratory, Department of Physiology and Biophysics, Faculty of Medicine, University of Chile, Independencia 1027, Santiago, 8389100, Chile.
Eric
E
Tapia
Membrane Biochemistry Laboratory, Department of Physiology and Biophysics, Faculty of Medicine, University of Chile, Independencia 1027, Santiago, 8389100, Chile. Electronic address: nlagos@med.uchile.cl.
Nestor
N
Lagos
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D012530:Saxitoxin / Q000031:analogs & derivatives* / Q000627:therapeutic use
D012530:Saxitoxin; C013007:gonyautoxins
Gonyautoxin; Long-acting pain blocker; PSP toxins; Pain management; Periarticular infiltration