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Intraosseous Sustained-Release Anesthetics Promote Early Ambulation and Functional Recovery After Total Knee
Junjie Huang1, Sohaib Hasan Abdullah Ezzi1, Song Wu1
1Department of Orthopaedics of the 3rd Xiangya Hospital, Central South University, China.
Background:
Postoperative pain is a primary impediment to functional recovery in patients who undergo total knee arthroplasty (TKA).This work aimed to evaluate the efficacy of intraosseous sustained-release anesthetics, administered into the subchondral trabecular space before the insertion of a prosthesis during TKA, in promoting early ambulation and functional recovery.
Methods:
This randomized controlled open-label study was carried out on 110 patients who had a mean age of 75 years (range, 65 to 90). Patients were subdivided into two groups: local infiltration anesthesia (LIA) group: 10 mL of sustained-release anesthetic injection solution was taken, and infiltration anesthesia was applied in the joint and around the incision (two mL was injected into the posterior joint capsule and lateral collateral ligaments, two mL was injected into the knee-extension device and the parapatellar, and six mL was injected into the periarticular soft tissues); and LIA + intraosseous infiltration anesthesia (TIA) or group LIA plus TIA: a sustained-release anesthetic injection solution of 20 mL, 10 mL as described before plus intraosseous infiltration anesthesia on the osteotomy surface of the tibia (10 mL).
Results:
Visual analog scale, at rest and during walking, was significantly lower at days one and three in the group LIA plus TIA than in the group LIA (P < 0.05). Patient-controlled epidural analgesia time was significantly higher in the experimental group (LIA plus TIA) than in the control group (LIA) (18.7 versus 14.8, P < 0.001). The walking distance was significantly higher on days one and three in the group LIA plus TIA than in the group LIA (P < 0.05). Flexion and range of motion were significantly higher at days one and three in the group LIA plus TIA than in the group LIA (P < 0.05). Flexion and range of motion were significantly higher at days one and three in the group LIA plus TIA than in the group LIA (P < 0.05).
Conclusions:
The intraosseous injection of liposomal bupivacaine may be a potentially effective method for post-TKA analgesia, significantly promoting early walking and functional recovery after TKA.
