PMID- 30238239
OWN - NLM
STAT- MEDLINE
DCOM- 20190531
LR  - 20200225
IS  - 1433-7347 (Electronic)
IS  - 0942-2056 (Print)
IS  - 0942-2056 (Linking)
VI  - 27
IP  - 4
DP  - 2019 Apr
TI  - Early stage periarticular injection during total knee arthroplasty may provide a 
      better postoperative pain relief than late-stage periarticular injection: a 
      randomized-controlled trial.
PG  - 1124-1131
LID - 10.1007/s00167-018-5140-y [doi]
AB  - PURPOSE: This study was performed to determine whether periarticular injection 
      performed in the early stage of total knee arthroplasty (TKA) could provide a 
      better postoperative pain relief than periarticular injection performed in the 
      late stage of TKA. The hypothesis was based on the concept that analgesic 
      intervention before the onset of noxious stimuli would be associated with less 
      postoperative pain. METHODS: A total of 105 participants were randomly assigned 
      to receive superficial injection just prior to arthrotomy (early stage 
      periarticular injection group) or superficial injection after implanting the 
      prosthesis (late-stage periarticular injection group) in patients undergoing 
      unilateral TKA with 1:1 treatment allocation. In both groups, deep injection was 
      performed according to the same schedule (just prior to implanting prosthesis). 
      The solution consisted of 300 mg of ropivacaine, 8 mg of morphine, 40 mg of 
      methylprednisolone, 50 mg of ketoprofen, and 0.3 mg of epinephrine mixed with 
      normal saline to a final volume of 60 mL. All surgeries were managed under 
      general anesthesia without any regional blocks. Registry-specified primary 
      outcome was postoperative pain score at rest measured at the recovery room using 
      a 100-mm visual analog scale (VAS). The VAS score was compared between two groups 
      and assessed to reach the reported threshold values for the minimal clinically 
      important difference (MCID) of 10 mm for the postoperative VAS score. RESULTS: 
      The VAS score at the recovery room was significantly lower in the early stage 
      periarticular injection group than the late-stage periarticular injection group 
      (23 +/- 25 mm versus 39 +/- 34 mm, respectively; 95% confidence interval 4-28 mm; 
      p = 0.0078). The mean difference in the primary outcome fulfilled the MCID value. 
      CONCLUSIONS: Bringing forward the timing of periarticular injection may provide 
      significant and clinically meaningful improvement in pain following TKA under 
      general anesthesia. LEVEL OF EVIDENCE: I.
FAU - Tsukada, Sachiyuki
AU  - Tsukada S
AUID- ORCID: 0000-0002-1186-5232
AD  - Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, 
      Mito, Ibaraki, 310-0035, Japan. s8058@nms.ac.jp.
FAU - Kurosaka, Kenji
AU  - Kurosaka K
AD  - Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, 
      Mito, Ibaraki, 310-0035, Japan.
FAU - Maeda, Tetsuyuki
AU  - Maeda T
AD  - Department of Anesthesiology, Hokusuikai Kinen Hospital, Mito, Japan.
FAU - Iida, Akihiro
AU  - Iida A
AD  - Department of Anesthesiology, Hokusuikai Kinen Hospital, Mito, Japan.
FAU - Nishino, Masahiro
AU  - Nishino M
AD  - Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, 
      Mito, Ibaraki, 310-0035, Japan.
FAU - Hirasawa, Naoyuki
AU  - Hirasawa N
AD  - Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, 
      Mito, Ibaraki, 310-0035, Japan.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20180920
PL  - Germany
TA  - Knee Surg Sports Traumatol Arthrosc
JT  - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
JID - 9314730
RN  - 0 (Analgesics)
RN  - 0 (Anesthetics, Local)
RN  - 76I7G6D29C (Morphine)
RN  - 7IO5LYA57N (Ropivacaine)
RN  - 90Y4QC304K (Ketoprofen)
RN  - YKH834O4BH (Epinephrine)
SB  - IM
MH  - Aged
MH  - Analgesics/administration & dosage
MH  - Anesthesia, General
MH  - Anesthetics, Local/*administration & dosage
MH  - *Arthroplasty, Replacement, Knee
MH  - Drug Administration Schedule
MH  - Epinephrine/administration & dosage
MH  - Female
MH  - Humans
MH  - *Injections, Intra-Articular
MH  - Ketoprofen/administration & dosage
MH  - Male
MH  - Middle Aged
MH  - Morphine/administration & dosage
MH  - Pain, Postoperative/*drug therapy
MH  - Prospective Studies
MH  - Ropivacaine/administration & dosage
MH  - Treatment Outcome
PMC - PMC6435609
OTO - NOTNLM
OT  - Injection technique
OT  - Pain
OT  - Periarticular injection
OT  - Pre-emptive analgesia
OT  - Primary knee arthroplasty
OT  - Randomized-controlled trial
COIS- CONFLICT OF INTEREST: All authors declare that they have no conflict of interest. 
      ETHICAL APPROVAL: The Ethics Committee of Hokusuikai Kinen Hospital provided 
      ethical oversight and study approval. All studies were conducted in adherence to 
      the Declaration of Helsinki. INFORMED CONSENT: All participants provided written 
      informed consent.
EDAT- 2018/09/22 06:00
MHDA- 2019/06/01 06:00
PMCR- 2018/09/20
CRDT- 2018/09/22 06:00
PHST- 2018/06/04 00:00 [received]
PHST- 2018/09/11 00:00 [accepted]
PHST- 2018/09/22 06:00 [pubmed]
PHST- 2019/06/01 06:00 [medline]
PHST- 2018/09/22 06:00 [entrez]
PHST- 2018/09/20 00:00 [pmc-release]
AID - 10.1007/s00167-018-5140-y [pii]
AID - 5140 [pii]
AID - 10.1007/s00167-018-5140-y [doi]
PST - ppublish
SO  - Knee Surg Sports Traumatol Arthrosc. 2019 Apr;27(4):1124-1131. doi: 
      10.1007/s00167-018-5140-y. Epub 2018 Sep 20.