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Adequate Pain Control May Facilitate Better Results in Total Knee and Hip Replacement Surgery: Presented at AAOS

By John Otrompke

CHICAGO, I.L. -- March 28, 2006 -- Two studies on the effects of periarticular injections in joint replacement cases are exploring whether more effective pain control can play any role in improving outcomes in such cases.

"Pain response in total hip arthroscopy (THA) is poorly-understood," said Hari Parvataneni, MD, chief resident, Lenox Hill Hospital, New York, New York, United States. "To be effective, any pain control regimen must act through all the pathways involved. Joint replacement surgery causes a huge cascade: you have a systemic response, a local response, neurological, and inflammatory."

Dr. Parvataneni presented the results of one trial and detailed preliminary results from a second one at the 2006 annual meeting of the American Academy of Orthopedic Surgeons (AAOS).

"Patients who are more comfortably achieve better physical therapy regimens, and they are less at risk for deep vein thrombosis and pulmonary embolism," said Ben Shore, MD, resident in orthopedic surgery, University of Western Ontario, London, Ontario, Canada, who presented a paper detailing results from a similar trial at his institution.

Dr. Parvataneni's group enrolled 50 patients undergoing total hip arthroscopy between 2003 and 2004. Before the operation, the patients received Vioxx (rofecoxib), oxycodone and coumadin. After the replacement, but prior to closure, a mixture of Marcaine (bupivacaine), morphine sulfate, DepoMedrol (methylprednisolone acetate), epinephrine, and Zinacef (cefuroxime) was injected into the periarticular ligament attachments and other sites.

Recovery of function was achieved earlier in 90% of patients; 74% of patients described their recovery as easy, and within six weeks, 60% of patients had no limp.

Dr. Shore's group randomized 128 patients undergoing knee or hip replacements into two groups, one of which received periarticular injections of ropivacaine, ketorolac, epimorphine, and epinephrine, and one group which received nothing.

Patients used about 50% less patient-controlled anesthetic (PCA) six hours after surgery, Dr. Shore said.

Both groups are currently enrolling patients for another study. Dr. Shore's group is randomizing patients for a trial that ultimately will include 200 patients, while Dr. Parvataneni's group has randomized 45 patients for a trial that will include 100 patients, testing the efficacy of the group's injected cocktail.

In patient populations with poorly-controlled pain, "the function of recovery, due to the physiological effect of pain, is delayed. Pain and the body's pain response negatively affect outcomes," Dr. Shore said.


[Presentation title: Modifying the Pain Response after THR using Local Periarticular Injections. Abstract 387. A Randomised Clinical Trial Assessing Efficacy of Peri-articular Injection in Total Joint Replacement. Abstract 386]

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