Comparative Study On The Efficacy Of Intra-articular Catheter Or Non-catheter Analgesia After Total Knee Arthroplasty

Objective: To study the effects of intra-articular catheter analgesia after total knee arthroplasty as compared with non-catheter analgesia,and try to demonstrate a more effective analgesia protocol.Methods: From June 2008 to December 2009, with the prospective, randomized comparative methods, 50 patients with osteoarthritis of the knee(OA) who were registered in our Hospital were selected,all of them were consistent with the operative indications and underwent the unilateral total knee arthroplasty (TKA).Including male 18 cases, female 32 cases, with an average age of 65 years (50～78 years), with an average body mass index (BMI) 22.4kg / m2 (17.5～27.8 kg / m2), the left knee in 23 cases, 27 cases of right knee.The average of range of motion(ROM) of the knee joint preoperatively was 99.5°(85～125°) and there were no valgus or varus deformities.They were divided into catheter trail group and non-catheter control group,25 cases each group. All of the patients were received periarticular injection "cocktail" mixture analgesia, while the trial group even received single-shot intra-articular infusion analgesic mixture (ropivacaine, Flurbiprofen axetil, epinephrine) through a built-in catheter for 1 day postoperatively, and the control group did not use catheter. Perioperative analgesia program were unified, not one use the patient-controlled analgesia(PCA)postoperatively.A comparison was done on pain visual analog scales(VAS)at rest and during activities for 3 days postoperatively, night-time sleep quality scores, the amount of narcotics consumption, patients'global satisfaction score(GSS), ROM of knee joint,the time of ability to perform an active straight leg raise reaching 45°, and walking with crutches.While observing the postoperative heart rate, blood pressure changes,the changes in Hb, as well as nausea, vomiting, urine retention, respiratory depression, wound healing and other related complications. The catheter trail group after extubation, routine bacterial culture and further drugs sensitivity were taken for the catheter tip in one of five patients. And all of the patients were received regular clinic or telephone follow-up to observe whether there is wound healing problems or deep infections occurred after discharged from hospital.Results: (1)Compared with the non-catheter control group,intra-articular catheter infusion analgesia mixture at 1 day postoperatively,significantly reduced the VAS pain score at rest for 24～48h and during activities for 2,3 days postoperatively,the differences was statistically significant (P <0.05), while the mean VAS pain scores at 0～24h postoperatively,discharge and 6w followup, there was no statistical difference in significance (P> 0.05).(2)The night-time sleep quality score and the total narcotics consumption for 3 days postoperatively were lower than that of control group,there were statistically significant differences(P <0.05). (3)The knee joint ROM for 3 days postoperatively, the time of ability to perform an active straight leg raising 45°,the first time of walking as well as the GSS, etc. were better in trial group than those in control group. (4) All of the five catheter tip bacterial culture results were negative;There were no one cases of heart and central nervous system toxicity and other complications, but each one cases of wound fat liquefaction, shallow exudate, after medication, partial pressure bandage, both of them were primary healing;Both groups in nausea, vomiting, urinary retention, respiratory depression, and poor wound healing complications, were no statistically significant differences(P> 0.05);At the end of outpatient visits or telephone follow-up,there were no one case of poor wound healing or prosthetic infection,etc.Conclusion: 1.intraoperative Periarticular injection "cocktail" mixture analgesia in combined postoperative single-shot intraarticular infusion analgesic mixture for TKA,can meet the ideal analgesia requirements for more than 36h postoperatively;ensure that patients went through the postoperative period of acute pain more comfortablely and easily.2. As compared to a single periarticular "cocktail" analgesia intraoperatively, intraarticular catheter infusion analgesia can significantly prolong the excellent pain relief postoperatively;make for the early functional training and promote joint functional recovery;avoid the systemic side effects of the use of opioid analgesics;and improve patients' GSS.3. Analgesia using this approach is practical, safe and effective.