Research Progress on the Application of "Cocktail" Therapy in Total Knee Arthroplasty
DOI:
https://doi.org/10.53469/jcmp.2024.06(12).29Keywords:
Knee osteoarthritis, Total knee arthroplasty, Cocktail therapy, Pain, Local injectionAbstract
Total knee arthroplasty is one of the important surgical methods for end-stage knee osteoarthritis in elderly patients. However, due to the large surgical trauma, postoperative pain may occur to varying degrees, which not only affects patients' functional exercise, delays limb rehabilitation and increases hospitalization time but also increases postoperative medical expenses and complications risks. In recent years, the widely used joint periarticular local infiltration "cocktail" has become an ideal combination therapy for multimodal analgesia. This method aims to prevent and control postoperative pain by co-injecting several drugs (formulated drugs) into the surrounding area of the joint. Currently, the "cocktail" formulation is constantly being improved, and there is still a lack of unified standards regarding its formulation, injection method, and site. This article will review recent research progress on the use of "cocktail" treatment in total knee arthroplasty both domestically and internationally.
References
Huang G, Hong W, Wang K, Xu M, Chen B, Qian D, Pei B. Causal analysis of bodycomposition measurements in osteoarthritis knee: a two-sample mendelian randomization study. BMC Musculoskelet Disord.2024 Apr 29;25(1):341. doi: 10.1186/s12891-024-07465-3.
Gaffney CJ, Pelt CE, Gililland JM, Peters CL. Perioperative Pain Management in Hip and Knee Arthroplasty. Orthop Clin North Am. 2017 Oct;48(4):407-419. doi: 10.1016/j.ocl.2017.05.001.
Dainese P, Wyngaert KV, De Mits S, et al. Association between knee inflammation and knee pain in patients with knee osteoarthritis: a systematic review[J]. Osteoarthritis and Cartilage, 2022, 30 (4): 516 － 534.
Zhou G, Ma L, Jing J, Jiang H. A meta-analysis of dexamethasone for pain management in patients with total knee arthroplasty. Medicine (Baltimore). 2018 Aug;97(35):e11753. doi: 10.1097/MD.0000000000011753.
Fan Z, Ma J, Kuang M, Zhang L, Han B, Yang B, Wang Y, Ma X. The efficacy of dexamethasone reducing postoperative pain and emesis after total knee arthroplasty:A systematic review and meta-analysis. Int J Surg. 2018Apr; 52: 149-155. doi: 10.1016/ j.ijsu. 2018.02.043.
Tan Z, Kang P, Pei F, Shen B, Zhou Z, Yang J. A comparison of adductorcanal block and femoral nerve block after total-knee arthroplasty regarding analgesic effect, effectiveness of early rehabilitation, and lateral knee pain relief in the early stage. Medicine (Baltimore). 2018 Nov;97(48):e13391. doi:10.1097/MD.0000000000013391.
Gui YK, Xiao R, Luo YR, Liu Y, Da X, Zhu SH, Shi DW, Hu XD, Xu GH. Analgesic Effects of Different Local Infiltration Anesthesia TechniquesCombined with Femoral Nerve Block in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Clinical Trial. Local Reg Anesth. 2023 Dec 22;16:183-192. doi: 10.2147/LRA.S436767.
Bianconi M, Ferraro L, Traina GC, et al. Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery[J]. Br J Anaesth, 2003, 91(6): 830⁃835.
LEI Yi-ting, PEI Fu-xing. Research progress of cocktail therapy for post-operative pain control in total knee arthroplasty.Chinese Journal of Bone and Joint, December 2016, Vol 5,No.12. DOI:10.3969/ j.issn.2095-252X.2016.12.01
Salwan A, Jadawala VH, Kekatpure AL, Ahmed S, Malhotra G, Parekh YC, Goyal S. Study of Efficacy of Extraosseous Local Infiltration of Multimodal Drug Cocktail for Pain Management After Total Joint Arthroplasty in Lower Limb. Cureus. 2024 Aug 22;16(8):e67483. doi: 10.7759/cureus.67483.
Di, S. and J. Huang. "Cocktail" therapy was used in total knee arthroplasty research progress [J]. Chinese Remedies & Clinics. 2022, 22(2): 188-192. doi:10.11655/zgywylc2022.02.027
Kg G, J R. Efficacy of Intraoperative Periarticular Local Infiltration for Pain Control and Ambulation in Total Knee Arthroplasty: A Randomized Case-Control Study. Cureus. 2024 Jan 20;16(1):e52639. doi: 10.7759/cureus.52639.
Motififard M, Zarezadeh A, Mohammadsharifi G. Comparing preemptive injection of peri-articular-multimodal drug with oral celexocib for postoperative pain management in total knee arthroplasty: A randomized clinical trial. J Res Med Sci. 2023 Jun 12;28:51. doi: 10.4103/jrms.JRMS_208_19.
Gramke HF, Petry JJ, Durieux ME, et al. Sublingual piroxicam for postoperative analgesia: preoperative venus postoperative administration: a randomized, double blind study[J]. Anesth Analg, 2006, 102(3): 755⁃788.
Martinsson T, Haegerstrand A, Dalsgaard CJ. Effects of ropivacaine on eicosanoid release from human granulocytes and endothelial cells in vitro. Inflamm Res. 1997;46:398–403. doi: 10.1007/s000110050210.
Salwan A, Jadawala VH, Kekatpure AL, Ahmed S, Malhotra G, Parekh YC, Goyal S. Study of Efficacy of Extraosseous Local Infiltration of Multimodal Drug Cocktail for Pain Management After Total Joint Arthroplasty in Lower Limb. Cureus. 2024 Aug 22;16(8):e67483. doi: 10.7759/cureus.67483.
Kelley TC, Adams MJ, Mulliken BD, et al. Efficacy of multimodal perioperative analgesia protocol with periarticular medication injection in total knee arthroplasty: a randomized, double-blinded study. J Arthroplasty, 2013, 28(8):1274-1277.
Iwakiri K, Minami Y, Ohta Y, Kobayashi A. Effect of periarticular morphine injection for total knee arthroplasty: a randomized, double‐blind trial. J Arthroplasty. 2017;32:1839–44.
Wang Q, Sun J, Hu Y, Zeng Y, Kang P. Effects of morphine on peri‐articular infiltration analgesia in total knee arthroplasty: a prospective, double‐blind, randomized controlled trial. Int Orthop. 2020;44:2587–95.
Wu Y, Lu X, Ma Y, Zeng Y, Bao X, Xiong H, Shen B. Perioperative multiple low-dose Dexamethasones improves postoperative clinical outcomes after Total knee arthroplasty. BMC Musculoskelet Disord. 2018 Dec 1;19(1):428. doi: 10.1186/s12891-018-2359-1.
Zheng Y, Li Y, Tian H. [Evaluation of early effectiveness of local infiltration anesthesia with compound betamethasone in total knee arthroplasty]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Jan 15;38(1):9-14. Chinese. doi: 10.7507/ 1002-1892.202309081.
Myles PS, Corcoran T. Benefits and Risks of Dexamethasone in Noncardiac Surgery. Anesthesiology. 2021 Nov 1;135(5):895-903. doi: 10.1097/ ALN.0000000000003898.
Zhong C, He R, Lu X, Zhong L, Lin DK, Liu J, Guo D. Would high-dose corticosteroid addition to multimodal cocktail periarticular injection contribute to prolonged pain control and better recovery following total knee arthroplasty?: study protocol fora randomized controlled trial. Trials. 2021 Oct 15;22(1):703. doi: 10.1186/s13063-021-05655-1.
Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. JArthroplasty. 2007 Sep;22(6Suppl 2):33-8. doi: 10.1016/j.arth.2007.03.034.
Luo Z, Zeng W, Chen X, Xiao Q, Chen A, Chen J, Wang H, Zhou Z. Cocktail of Ropivacaine, Morphine, and Diprospan Reduces Pain and Prolongs Analgesic Effects after Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. Int J Clin Pract. 2024 Feb 28;2024:3697846. doi: 10.1155/2024/3697846.
Kulkarni M, Mallesh M, Wakankar H, et al. Effect of methylprednisolone in periarticular infiltration for primary total knee arthroplasty on pain and rehabilitation [J]. J Arthroplasty, 2019, 34: 1646-1649. DOI: 10. 1016/j. arth. 2019. 04. 060.
Albrecht E, Kirkham KR, Liu SS, Brull R. Peri-operative intravenous administration of magnesium sulphate and postoperative pain: a meta-analysis. Anaesthesia. 2013;68(1):79–90. doi: 10.1111/ j.1365-2044.2012.07335.x.
Oh TK, Chung SH, Park J, Shin H, Chang CB, Kim TK, Do SH. Effects of perioperative magnesium sulfate administration on postoperative chronic knee pain in patients undergoing total knee arthroplasty: a retrospective evaluation. J Clin Med. 2019;8(12):2231. doi: 10.3390/jcm8122231.
Shin HJ, Kim EY, Na HS, Kim TK, Kim MH, Do SH. Magnesium sulphate attenuates acute postoperative pain and increased pain intensity after surgical injury in staged bilateral total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial. Br J Anaesth. 2016;117(4):497–503. doi: 10.1093/bja/aew227.
Kreutzwiser D & Tawfic QA. Expanding role of NMDA receptor antagonists in the management of pain. CNS Drugs 201933347–374. (10.1007/s40263-019-00618-2)
Zhao C, Wang L, Chen L, Wang Q, Kang P. Effects of magnesium sulfate on periarticular infiltration analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled trial. J Orthop Surg Res. 2023 Apr 14;18(1):301. doi: 10.1186/s13018-023-03790-w.
Wang Q, Li F, Yang Y, Yue C, Guo J. Magnesium sulfate enhances the effect of the peripheral analgesic cocktail in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. EFORT Open Rev. 2024 Sep 2;9(9):896-907. doi: 10.1530/EOR-23-0185.
Zoratto D, Phelan R, Hopman WM, Wood GCA, Shyam V, DuMerton D, Shelley J, McQuaide S, Kanee L, Ho AMH, et al.Adductor canal block with or without added magnesium sulfate following total knee arthroplasty: a multi-arm randomized controlled trial. Canadian Journal of Anesthesia 2021681028–1037. (10.1007/s12630-021-01985-5)
Singh H, Agarwal KK, Tyagi S, Makadia P, Oza B, Jain P, Patel M. Peroperative Intra-Articular Infiltration of Tranexamic Acid and Ropivacaine Cocktail in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial. Cureus. 2022 Mar 12;14(3):e23091. doi: 10.7759/cureus.23091.
Mortazavi SMJ, Vosoughi F, Yekaninejad M, Ghadimi E, Kaseb MH, Firoozabadi MA, Fallah E, Toofan H, Pestehei SK. Comparison of the Effect of Intra-Articular, Periarticular, and Combined Injection of Analgesic on Pain Following Total Knee Arthroplasty: A Double-Blinded Randomized Clinical Trial. JB JS Open Access. 2022 Oct 7;7(4):e22.00074. doi: 10.2106/ JBJS.OA.22.00074.
Li K, Hou Y, Wang S, Li Z. Efficacy of different ways of cocktail analgesic mixture injection on total knee arthroplasty. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2020 Apr 28;45(4):406-410. English, Chinese. doi: 10.11817/j.issn.1672-7347.2020.180801.
Nakai T, Tamaki M, Nakamura T, Nakai T, Onishi A, Hashimoto K. Controlling pain after total knee arthroplasty using a multimodal protocol with local periarticular injections. J Orthop. 2013 Mar 17;10(2):92-4. doi: 10.1016/j.jor.2013.02.001.
L. Xintian, W. Wei, L. Jin, et al. Efficacy of improved cocktail therapy for pain control in unilateral total knee anthroplasty. Chinese Journal of Bone and Joint Surgery.2017, 10(04): 298-301. doi:10.3969/j.issn.2095-9958.2017.04-05
Wang Y, Zhou A. A new improvement: subperiosteal cocktail application to effectively reduce pain and blood loss after total knee arthroplasty. J Orthop Surg Res. 2020 Jan 30;15(1):33. doi: 10.1186/s13018-020-1563-5.
S. Wang, Y. Wu, Y. He, et al. Clinical study of continuous femoral nerve block combined with cocktail therapy for postoperative analgesia after total knee arthroplasty [J]. Gansu Medical Journal. 2020, 39(03): 212-215. doi:10.15975/j.cnki.gsyy.2020.03.008
Yuenyongviwat V, Wuttiworawanit B, Panichnantho N, Hongnaparak T, Iamthanaporn K. Efficacy of Periarticular Infiltration with Dexamethasone and Bupivacaine plus Adductor Canal Block Relative to That of Adductor Canal Block Alone for Patients Undergoing Total Knee Arthroplasty: A Retrospective Case-Matched Study. Adv Orthop. 2023 Oct 12;2023:7356192. doi: 10.1155/2023/7356192.
Luo ZY, Yu QP, Zeng WN, Xiao Q, Chen X, Wang HY, Zhou Z. Adductor canal block combined with local infiltration analgesia with morphine and betamethasone show superior analgesic effect than local infiltration analgesia alone for total knee arthroplasty: a prospective randomized controlled trial. BMC Musculoskelet Disord. 2022 May 19;23(1):468. doi: 10.1186/ s12891-022-05388-5.
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