The effect of pre-incisional wound site infiltration with multimodal analgesia on postoperative pain in total knee arthroplasty

Abstract

Background: Though Total knee arthroplasty (TKA) is an effective treatment method for osteoarthritis, insuffient postoperative pain management affects paitents satisfaction and functional results. To an effective postoperative pain management, several methods are used for analgesia. Aim of this study was to evaluate the effect  of the application of pre-incisional wound site infiltration on postoperative analgesia, additional to multi-modal analgesia methods for the provision of analgesia following Total Knee Arthroplasty. Material and methods: Total of 80 patients aged ?55 years posted to undergo TKA were randomly separated into 2 groups. Pre-incisional injection was administered to the skin for the group I patients, wherreas patiemts of group II were not administered pre-incisional injection. For postoperative pain management additional multi-modal analgesia methods were applied in both groups. To evaluate the level of postoperative pain, a Visual Analog Scale (VAS) score at rest and dynamic VAS (DVAS) during activity were used. The time of requirement for first analgesia and the amount of analgesia required were recorded. The patients were monitored throughout the operation and in the postoperative period for side-effects. Results: Postoperative VAS scores of Group I were found to be statistically significantly lower than those of Group II (p<0.05). The DVAS scores which were evaluated together with mobilisation, determined to be statistically significantly lower in Group I (p<0.05). The time of requirement for analgesia was determined to be later in Group I and the total amount of analgesia administered in the postoperative period was lower in Group I. No statistically significant difference was determined between the two groups in side-effects. Conclusion: The application of pre-incisional infiltration can be considered to be a safe and effective method, which is easy to apply and has low potential for side-effects, while increasing the efficacy of multi-modal analgesia..