PMID- 38450292
OWN - NLM
STAT- MEDLINE
DCOM- 20240308
LR  - 20240308
IS  - 1742-1241 (Electronic)
IS  - 1368-5031 (Print)
IS  - 1368-5031 (Linking)
VI  - 2024
DP  - 2024
TI  - Cocktail of Ropivacaine, Morphine, and Diprospan Reduces Pain and Prolongs 
      Analgesic Effects after Total Knee Arthroplasty: A Prospective Randomized 
      Controlled Trial.
PG  - 3697846
LID - 10.1155/2024/3697846 [doi]
LID - 3697846
AB  - BACKGROUND: Local infiltration analgesia (LIA) provides postoperative analgesia 
      for total knee arthroplasty (TKA). The purpose of this study was to evaluate the 
      analgesic effect of a cocktail of ropivacaine, morphine, and Diprospan for TKA. 
      METHODS: A total of 100 patients from September 2018 to February 2019 were 
      randomized into 2 groups. Group A (control group, 50 patients) received LIA of 
      ropivacaine alone (80 ml, 0.25% ropivacaine). Group B (LIA group, 50 patients) 
      received an LIA cocktail of ropivacaine, morphine, and Diprospan (80 ml, 0.25% 
      ropivacaine, 0.125 mg/ml morphine, and 62.5 mug/ml compound betamethasone). The 
      primary outcomes were the levels of inflammatory markers C-reactive protein (CRP) 
      and interleukin-6 (IL-6), pain visual analog scale (VAS) scores, opioid 
      consumption, range of motion (ROM), functional tests, and sleeping quality. The 
      secondary outcomes were adverse events, satisfaction rates, HSS scores, and SF-12 
      scores. The longest follow-up was 2 years. RESULTS: The two groups showed no 
      differences in terms of characteristics (P  >  0.05). Group B had lower resting 
      VAS pain scores (1.54 +/- 0.60, 95% CI = 1.37 to 1.70 vs. 2.00 +/- 0.63, 95% 
      CI = 2.05 to 2.34) and active VAS pain scores (2.64 +/- 0.62, 95% CI = 2.46 to 2.81 
      vs. 3.16 +/- 0.75, 95% CI = 2.95 to 3.36) within 48 h postoperatively than Group A 
      (P < 0.001), while none of the pain differences exceeded the minimal clinically 
      important difference (MCID). Group B had significantly lower CRP levels 
      (59.49 +/- 13.01, 95% CI = 55.88 to 63.09 vs. 65.95 +/- 14.41, 95% CI = 61.95 to 
      69.94) and IL-6 levels (44.11 +/- 13.67, 95% CI = 40.32 to 47.89 vs. 60.72 +/- 15.49, 
      95% CI = 56.42 to 65.01), lower opioid consumption (7.60 +/- 11.10, 95% CI = 4.52 
      to 10.67 vs. 13.80 +/- 14.68, 95% CI = 9.73 to 17.86), better ROM (110.20 +/- 10.46, 
      95% CI = 107.30 to 113.09 vs. 105.30 +/- 10.02, 95% CI = 102.52 to 108.07), better 
      sleep quality (3.40 +/- 1.03, 95% CI = 3.11 to 3.68 vs. 4.20 +/- 1.06, 95% CI = 3.90 
      to 4.49), and higher satisfaction rates than Group A within 48 h postoperatively 
      (P  <  0.05). Adverse events, HSS scores, and SF-12 scores were not significantly 
      different within 2 years postoperatively. CONCLUSIONS: A cocktail of ropivacaine, 
      morphine, and Diprospan prolongs the analgesic effect up to 48 h postoperatively. 
      Although the small statistical benefit may not result in MCID, the LIA cocktail 
      still reduces opioid consumption, results in better sleeping quality and faster 
      rehabilitation, and does not increase adverse events. Therefore, cocktails of 
      ropivacaine, morphine, and Diprospan have good application value for pain control 
      in TKA. This trial is registered with ChiCTR1800018372.
CI  - Copyright (c) 2024 Zhenyu Luo et al.
FAU - Luo, Zhenyu
AU  - Luo Z
AUID- ORCID: 0000-0001-6425-1544
AD  - Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, 
      West China School of Medicine, Sichuan University, Chengdu 610041, China.
FAU - Zeng, Weinan
AU  - Zeng W
AUID- ORCID: 0000-0002-3952-1968
AD  - Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, 
      West China School of Medicine, Sichuan University, Chengdu 610041, China.
FAU - Chen, Xi
AU  - Chen X
AUID- ORCID: 0000-0002-5166-0872
AD  - Department of Operative Dentistry and Endodontics, West China Hospital of 
      Stomatology, Sichuan University, Chengdu 610041, China.
FAU - Xiao, Qiang
AU  - Xiao Q
AUID- ORCID: 0000-0002-3018-1784
AD  - Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, 
      West China School of Medicine, Sichuan University, Chengdu 610041, China.
FAU - Chen, Anjing
AU  - Chen A
AUID- ORCID: 0000-0003-3139-4009
AD  - Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, 
      West China School of Medicine, Sichuan University, Chengdu 610041, China.
FAU - Chen, Jiali
AU  - Chen J
AUID- ORCID: 0000-0002-1227-4952
AD  - Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, 
      West China School of Medicine, Sichuan University, Chengdu 610041, China.
AD  - Department of Orthopedics, West China Hospital, West China School of Nursing, 
      Sichuan University, Chengdu 610041, China.
FAU - Wang, Haoyang
AU  - Wang H
AUID- ORCID: 0000-0003-3801-1226
AD  - Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, 
      West China School of Medicine, Sichuan University, Chengdu 610041, China.
FAU - Zhou, Zongke
AU  - Zhou Z
AUID- ORCID: 0000-0002-9037-4756
AD  - Department of Orthopedics, Institute of Orthopedic Research, West China Hospital, 
      West China School of Medicine, Sichuan University, Chengdu 610041, China.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20240228
PL  - India
TA  - Int J Clin Pract
JT  - International journal of clinical practice
JID - 9712381
RN  - 7IO5LYA57N (Ropivacaine)
RN  - 76I7G6D29C (Morphine)
RN  - 0 (betamethasone dipropionate, betamethasone sodium phosphate drug combination)
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Interleukin-6)
RN  - 9842X06Q6M (Betamethasone)
RN  - 0 (Drug Combinations)
SB  - IM
MH  - Humans
MH  - Ropivacaine/therapeutic use
MH  - *Arthroplasty, Replacement, Knee/adverse effects
MH  - Morphine/therapeutic use
MH  - Analgesics, Opioid/therapeutic use
MH  - Interleukin-6
MH  - Prospective Studies
MH  - Pain
MH  - Betamethasone/*analogs & derivatives
MH  - Drug Combinations
PMC - PMC10917473
COIS- The authors declare that they have no conflicts of interest.
EDAT- 2024/03/07 06:43
MHDA- 2024/03/08 06:42
PMCR- 2024/02/28
CRDT- 2024/03/07 04:18
PHST- 2022/10/29 00:00 [received]
PHST- 2023/11/26 00:00 [revised]
PHST- 2024/01/17 00:00 [accepted]
PHST- 2024/03/08 06:42 [medline]
PHST- 2024/03/07 06:43 [pubmed]
PHST- 2024/03/07 04:18 [entrez]
PHST- 2024/02/28 00:00 [pmc-release]
AID - 10.1155/2024/3697846 [doi]
PST - epublish
SO  - Int J Clin Pract. 2024 Feb 28;2024:3697846. doi: 10.1155/2024/3697846. 
      eCollection 2024.