ORIGINAL PAPER
Assessment of the effectiveness of the application of a mixture containing opioids and NSAID administered intraoperatively to the wound in treating pain in patients after postoperative pain total knee arthroplasty
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Online publication date: 2011-06-06
Reumatologia 2011;49(3):173-179
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ABSTRACT
Postoperative pain belongs to the acute pain category and accompanies every surgery. Total knee arthroplasty is an example of repair surgery that can relieve the patient from the chronic pain associated with irreversible damage of the knee. The concept of multimodal analgesia applied so far in patients after orthopaedic surgery has involved the use of different classes of analgesics and different analgesia techniques. However, none of the analgesics was administered directly into the operation wound. The aim of the study was to evaluate the efficiency of an analgesic mixture including non-steroidal anti-inflammatory drugs (NSAIDs) and opioid injected directly into the operation wound. The study included 40 patients with rheumatoid arthritis (RA) and osteoarthritis (OA) who underwent TKA under spinal anaesthesia with the use of 20 mg of bupivacaine 0.5% spinal heavy at the L3-L4 level (Table I). The control group consisted of patients who received 0.4 mg of spinal morphine. This group of patients did not participate in the study. Apart from the basic parameters such as HR, RR, and Sp02, the pain according to VAS (Fig. 2, 3) was also evaluated as well as the drainage (Fig. 5) and the wound healing process 7 days after the surgery (clinical evaluation). The results describing the analgesia time in different groups showed that the longest time of analgesia occurred in the group that received 0.4 mg of spinal morphine, whereas the direct injection of analgesic mixture into the operation wound allowed for 5 hours analgesia (Fig. 1). The use of the analgesic mixture has reduced the use of postoperative systemic opioids. No negative effects on the process of wound healing were found (Fig. 4). The analgesic mixture allowed for the adequate postoperative pain analgesia.
REFERENCES (26)
1.
Zimmerman-Górska I. Reumatologia kliniczna. Tom 1, część 1, rozdz. 17.4. Wydawnictwo Lekarskie PZWL, Warszawa 2009; 393-394. .
2.
Dobrogowski J, Mayzner-Zawadzka E, Drobnik L i wsp. Uśmierzanie bólu pooperacyjnego. Ból 2008; 9: 3-16. .
3.
Skinner HB. Multimodal acute pain management. Am J Orthop 2004; 33: 5-9. .
4.
Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 2008; 79: 174-183. .
5.
Andersen LO/, Husted H, Otte KS, et al. High-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand 2008; 52: 1331-1335. .
6.
Essving P, Axelsson K, Kjellberg J, et al. Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplasty. Acta Orthop 2009; 80: 213-219. .
7.
Essving P, Axelsson K, Kjellberg J, et al. Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty. Acta Orthop 2010; 81: 354-360. .
8.
McNaught AF, McCartney C. Bupivacaine chondrotoxicity. Br J Anaesth 2009; 103: 133; author reply 133-134. .
9.
Webb ST, Ghosh S. Intra-articular bupivacaine: potentially chondrotoxic? Br J Anaesth 2009; 102: 439-441. .
10.
Lo IK, Sciore P, Chung M, et al. Local anesthetics induce chondrocyte death in bovine articular cartilage disks in a dose- and duration-dependent manner. Arthroscopy 2009; 25: 707-715. .
11.
Grabowska-Gaweł A, Gaweł K, Hagner W, Biliński P. Morfina czy bupiwakaina w zwalczaniu bólu pooperacyjnego u chorych poddanych artroskopii stawu kolanowego. Ortopedia, Traumatologia, Rehabilitacja 2003; 5: 758-762. .
12.
Chitre AR, Fehily MJ, Bamford DJ. Total hip replacement after intra-articular injection of local anaesthetic and steroid. J Bone Joint Surg Br 2007; 89: 166-168. .
13.
Fu P, Wu Y, Wu H, et al. Efficacy of intra-articular cocktail analgesic injection in total knee arthroplasty – a randomized controlled trial. Knee 2009; 16: 280-284. .
14.
Chen DW, Hsieh PH, Huang KC, et al. Continuous intra-articular infusion of bupivacaine for post-operative pain relief after total hip arthroplasty: a randomized, placebo-controlled, double-blind study. Eur J Pain 2010; 14: 529-534. .
15.
Andersen LJ, Poulsen T, Krogh B, Nielsen T. Postoperative analgesia in total hip arthroplasty: a randomized double-blinded, placebo-controlled study on peroperative and postoperative ropivacaine, ketorolac, and adrenaline wound infiltration. Acta Orthop 2007; 78: 187-192. .
16.
Morin AM, Wulf H. High volume local infiltration analgesia (LIA) for total hip and knee arthroplasty: a brief review of the current status. Anasthesiol Intensivmed Notfallmed Schmerzther 2011; 46: 84-86. .
17.
Busch CA, Shore BJ, Bhandari R, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 2006; 88: 959-963. .
18.
Andersen KV, Bak M, Christensen BV, et al. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty. Acta Orthop 2010; 81: 606-610. .
19.
Bryen PMO, Persson CAG, Church MK. Komórkowe i mediatorowe mechanizmy odpowiedzi immunologicznej. W: Alergie. Holgate ST, Church MK, Lichtenstein LM (red.). Wydawnictwo Czelej, Lublin 2005; 325-327. .
20.
Lisowska B. Wpływ opioidów na układ immunologiczny. Anestezjologia i Ratownictwo 2007; 2: 90-94. .
21.
Krajnik M, Żylicz Z. Mechanizm działania przeciwbólowego opioidów. Polska Medycyna Paliatywna 2003; 2: 111-118. .
22.
Dobrogowski J, Wordliczek J. Medycyna Bólu, PZWL 2004; 5: 319-320. .
23.
Lisowska B, Słowińska I, Małdyk P, Ćwiek R. Analgezja pooperacyjna z zastosowaniem Morfini Sulfas Spinal po operacjach artroskopowych stawów kolanowych. Anestezjologia i Ratownictwo 2007; 1: 36-41. .
24.
Liu W, Cong R, Li X, et al. Reduced opioid consumption and improved early rehabilitation with local and intraarticular cocktail analgesic injection in total hip arthroplasty: a randomized controlled clinical trial. Pain Med 2011; 12: 387-393. .
25.
Essving P, Axelsson K, Kjellberg J, et al. Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplasty. Acta Orthop 2009; 80: 213-219. .
26.
Wen-Hsiang S, Ming-Huei C, Wen-Ling L, et al. Nonsteroidal anti-inflammatory drugs for wounds: pain relief or excessive scar formation? Mediators Inflamm 2010; 2010: 413238.
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