Does The Continuous Intraarticular Pain Pump Effective To Decrease The Pain After Total Knee Arthroplasty?

Abstract

Aims: This study aims to put forth the results of continuous intraarticular pain pump administration after total knee arthroplasty. Material and Methods: This retrospective study was conducted on bilateral knee arthroplasty surgery patients. The patients who used only a one-sided continuous intraarticular pain pump were investigated. The Visual analogue scale(VAS), at the 8th hour, 24th hour, 2nd week and 1st month and the range of motion (ROM) at the 24th hour, 2nd week and 1st month were evaluated at both knees. Results: Twenty-six patients (25 female, 1 male) met the study criteria. The mean age was 71.66∓5.07 years (63-81years). The continuous intraarticular pain pump used knees were associated with a significant decrease in the VAS at the 8th and 24th hours. Though there were no differences in the range of motion between pain pump used and non-used knees at the 48th, 2nd week and 1st month. No pain pump-related complications were detected. Conclusion: Using a continuous intraarticular pain pump is effective in treating pain after total knee prosthesis. This benefit on pain relief does not make a significant difference in the range of motion of the knee.

Keywords

• TKA
• Pain
• Control

References

1. Horlocker TT. Pain management in total joint arthroplasty:a historical review. Orthopaedics 2010;33(9):14-19.
2. Korean Knee Society. Guidelines for the management of postoperative pain after total knee arthroplasty. Knee Surg Relat Res. 2012;24(4):201-207.
3. Mauerjan DR, Campbell M, Miller JS, Mokris JG, Gregory A, Kiebzak GM. Intra-articular morphine and/or bupivacaine in the management of pain after total knee arthroplasty. J Arthroplasty. 1997;12(5):546-552.
4. Gómez-Cardero P, Rodríguez-Merchán EC. Postoperative analgesia in TKA: ropivacaine continuous intraarticular infusion. Clin Orthop Relat Res. 2010;468(5):1242-1247.
5. Bonica JJ. Postoperative pain. In: Bonica JJ (ed): The management of pain. (2nd ed). Philadelphia: Lea and Febiger, 1990, pp. 461-480.
6. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA. 2003;290(18):2455-2463.
7. Jakobsen TL, Kehlet H, Husted H, Petersen J, Bandholm T. Early progressive strength training to enhance recovery after fast-track total knee arthroplasty: a randomized controlled trial. Arthritis Care Res (Hoboken). 2014;66(12):1856-1866.
8. Pelt CE, Anderson AW, Anderson MB, Van Dine C, Peters CL. Postoperative falls after total knee arthroplasty in patients with a femoral nerve catheter: can we reduce the incidence?. J Arthroplasty. 2014;29(6):1154-1157.

9. Ali A, Sundberg M, Hansson U, Malmvik J, Flivik G. Doubtful effect of continuous intraarticular analgesia after total knee arthroplasty: a randomized double-blind study of 200 patients. Acta Orthop. 2015;86(3):373-377.
10. Williams D, Petruccelli D, Paul J, Piccirillo L, Winemaker M, de Beer J. Continuous infusion of bupivacaine following total knee arthroplasty: a randomized control trial pilot study. J Arthroplasty. 2013;28(3):479–484.
11. Rasmussen S, Kramhøft MU, Sperling KP, Pedersen JHL. Increased flexion and reduced hospital stay with continuous intraarticular morphine and ropivacaine after primary total knee replacement: open intervention study of efficacy and safety in 154 patients. Acta Orthop Scand. 2004;75(5):606-609.
12. Ong JC, Chin PL, Fook-Chong SM, Tang A, Yang KY, Tay BK. Continuous infiltration of local anesthetic following total knee arthroplasty. J Orthop Surg (Hong Kong). 2010;18(2):203-207.
13. Goyal N, McKenzie J, Sharkey PF, Parvizi J, Hozack WJ, Austin MS. The 2012 Chitranjan Ranawat award: intraarticular analgesia after TKA reduces pain: a randomized, double-blinded, placebo-controlled, prospective study. Clin Orthop Relat Res. 2013;471(1):64-75.
14. Mullaji A, Kanna R, Shetty GM, Chavda V, Singh DP. Efficacy of periarticular injection of bupivacaine, fentanyl, and methylprednisolone in total knee arthroplasty: a prospective, randomized trial. J Arthroplasty. 2010;25(6):851-857.
15. 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(5):959-963.
16. Zhang Y, Lu M, Chang C. Local anesthetic infusion pump for pain management following total knee arthroplasty: a meta-analysis. BMC Musculoskelet Disord. 2017;18(1):32. Published 2017 Jan 23.
17. Abbot Laboratories. Bupivacaine hydrochloride injection and epinephrine injection package inserts. North Chicago, IL: Abbot Laboratories, 1998.