Teya Tietje1, Andrew B Davis2, Michael P Rivey3. 1. Skaggs School of Pharmacy, University of Montana, Missoula, MT, USA teyatietjepharmd@gmail.com. 2. Pharmacy Department, Community Medical Center, Missoula, MT, USA. 3. Pharmacy Department, Johnson City Medical Center, Johnson City, TN, USA.
Abstract
BACKGROUND: It is estimated that up to 50% of patients undergoing total knee arthroplasty (TKA) receive suboptimal postoperative pain management. METHODS: In a retrospective study, 224 patients who underwent TKA between January 1, 2011, and September 30, 2012, were identified by surgical records for 2 surgeons at Community Medical Center in Missoula, Montana. Patient records were reviewed and data collected for patient hospital length of stay (LOS), postoperative opioid use, opioid-associated adverse events, and nonopioid analgesic use. Data were analyzed for differences in outcomes between patients who received an intraoperative intra-articular (IOIA) injection followed by a postoperative infusion (0.25%-0.5% bupivacaine) or an intraoperative periarticular (IOPA) injection (ropivacaine, ketorolac, epinephrine, and clonidine) for sustained analgesia after TKA. RESULTS: Patients who received an IOPA injection had a statistically significant decrease in hospital LOS (67.0 vs 75.9 hours; P = .027) and postoperative nausea and vomiting (39.3% vs 54.9%; P = .023) when compared to patients who received an IOIA infusion. The incidence of having either oversedation or pruritus did not differ between groups (9.8% vs 9.8%; P = 1.00). CONCLUSION: The use of IOPA injections containing ropivacaine, epinephrine, ketorolac, and clonidine during TKA offered some benefit over IOIA infusions containing 0.25% to 0.5% bupivacaine at our institution.
BACKGROUND: It is estimated that up to 50% of patients undergoing total knee arthroplasty (TKA) receive suboptimal postoperative pain management. METHODS: In a retrospective study, 224 patients who underwent TKA between January 1, 2011, and September 30, 2012, were identified by surgical records for 2 surgeons at Community Medical Center in Missoula, Montana. Patient records were reviewed and data collected for patient hospital length of stay (LOS), postoperative opioid use, opioid-associated adverse events, and nonopioid analgesic use. Data were analyzed for differences in outcomes between patients who received an intraoperative intra-articular (IOIA) injection followed by a postoperative infusion (0.25%-0.5% bupivacaine) or an intraoperative periarticular (IOPA) injection (ropivacaine, ketorolac, epinephrine, and clonidine) for sustained analgesia after TKA. RESULTS:Patients who received an IOPA injection had a statistically significant decrease in hospital LOS (67.0 vs 75.9 hours; P = .027) and postoperative nausea and vomiting (39.3% vs 54.9%; P = .023) when compared to patients who received an IOIA infusion. The incidence of having either oversedation or pruritus did not differ between groups (9.8% vs 9.8%; P = 1.00). CONCLUSION: The use of IOPA injections containing ropivacaine, epinephrine, ketorolac, and clonidine during TKA offered some benefit over IOIA infusions containing 0.25% to 0.5% bupivacaine at our institution.