A Comparative Study between Local Infiltration of Ropivacaine Cocktail and Post-operative Epidural Bupivacaine in...

Post-operative pain following total knee arthroplasty (TKA) poses a significant challenge, often limiting early mobilization and delaying rehabilitation. While epidural analgesia with bupivacaine has been widely used, it is associated with complications such as motor block and hypotension, which may impair functional recovery. Local infiltration analgesia (LIA) using ropivacaine-based cocktails has emerged as a potential alternative with a better safety profile and effective pain control.

This prospective, randomized comparative study was conducted on 50 patients undergoing primary TKA. The participants were divided into two groups: Group A received intra-articular infiltration of 150 mg of 0.75% ropivacaine combined with ketorolac, adrenaline, and clonidine at the end of surgery, whereas Group B received post-operative epidural infusion of 0.125% bupivacaine. Post-operative pain was assessed using the Visual Analog Scale (VAS) at 6, 12, 18, 24, and 48 h. Additional outcomes measured included the need for rescue analgesia, the incidence of complications (motor block, hypotension, nausea, and vomiting), and functional outcomes such as time to ambulation and range of motion (ROM).

The study demonstrated that Group A had significantly lower VAS scores at all time intervals, indicating better analgesic efficacy. Only 32% of patients in Group A required rescue analgesia compared to 84% in Group B. Moreover, Group B had a higher incidence of motor block and hypotension, which adversely affected early mobilization. Nausea and vomiting were also more commonly observed in Group B. Patients in the local infiltration analgesia group showed improved functional outcomes, including earlier ambulation and better ROM at 48 h postoperatively.

Local infiltration of a ropivacaine cocktail offers superior pain relief, reduces the need for rescue analgesia, and results in fewer complications compared to post-operative epidural bupivacaine. This technique facilitates faster recovery and enhances patient satisfaction following total knee replacement, making it a safer and more effective approach for post-operative analgesia.