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General Orthopaedics

COMPARISON OF ANALGESIC REQUIREMENTS IN THE FIRST 24 HOURS FOLLOWING TOTAL KNEE ARTHOPLASTY IN PATIENTS WITH OR WITHOUT PERIARTICULAR CHIROCAINE ADMINISTRATION: A RETROSPECTIVE ANALYSIS OF CASE NOTES

Combined Irish Orthopaedic Association, Welsh Orthopaedic Association, Scottish Orthopaedic Association (IOA, WOA, SOA)



Abstract

Background

Post operative analgesia is an important part of Total Knee Arthroplasty (TKA) to facilitate early mobilisation and patient satisfaction. We investigated the effect of periarticular infiltration of the joint with chirocaine local anaesthetic (LA) on the requirement of analgesic in the first 24 hrs period post op.

Methods

Retrospective analysis of case notes was carried out on 28 patients, who underwent TKA by two different surgeons. They were divided into two groups of 14 each; who did and did not receive the LA infiltration respectively. All patients were given spinal morphine (162 mcg r: 150-200). Analgesic requirement was assessed in terms of the amount of paracetamol, morphine, diclofenac, oxynorm and tramadol administered in 24hrs post op including the operating time.

Results

Following results were obtained from patients receiving LA infiltration vs no infiltration: Morphine; 70 mg vs 200 mg, Paracetamol; 60 gm vs 58 gms, Diclofenac; 1650 mg vs 1050 mg, Oxynorm; 40 mg vs 80 mg, Tramadol; 200 mg vs 400 mg. Average length of stay (LOS) was 6 days (r: 3-8) in both groups.

Conclusion

From this study it may be concluded that periarticular LA infiltration reduces the requirement of morphine in first 24 hrs by almost 1/3rd. The amount of tramadol and oxynorm was also halved in LA infiltrated group although the requirement of paracetamol remained the same. LA infiltrated group received almost 1.5 times more Diclofenac as compared to the non infiltrated group. The LOS was not affected by the administration of LA.