Safety of steroid-containing cocktail periarticular injection after knee arthroplasty: A meta-analysis / 中国组织工程研究

BACKGROUND: Steroids have strong anti-inflammatory, anti-emetic and analgesic effects and are widely used in perioperative analgesia. Studies have shown that periarticular injection of steroid-containing cocktail analgesic therapy in knee arthroplasty can relieve postoperative pain, improve knee activity, and reduce complications. However, the other studies show that steroids can increase the risk of postoperative infection, and tendon rupture. Therefore, the safety and efficacy of steroid-containing cocktail periarticular injection in knee arthroplasty is still controversial. OBJECTIVE: To evaluate the safety and efficacy of steroid-containing cocktail periarticular injection after knee arthroplasty by meta-analysis. METHODS: The published literatures were searched on the databases of PubMed/Medline, Cochrane Central Register of Controlled Trials, and EMBASE until April 2019. All randomized controlled trials of topical steroid analgesia after knee arthroplasty were collected and eligible articles were screened. Two researchers independently assessed the risk of bias and methodological quality of included studies by the Cochrane 5.0. The outcome data were extracted and a meta-analysis was conducted by Review Manager 5.2 software. RESULTS AND CONCLUSION: (1) A total of 10 randomized controlled articles involving 820 patients were included. (2) The meta-analysis showed that visual analogue scale score was lower in the steroid group than in the control group at postoperative 1 day [MD=-1.52, 95%C/(-2.94, -0.10), P=0.04]. Motion range was higher in the steroid group than in the control group at postoperative 1, 2, 3,4 and 5 days [MD=11.57, 95%C/(9.85, 13.30), P < 0.000 01; MD=9.03, 95%C/(B.67, 11.38), P < 0.000 01; MD=5.73, 95%C/(0.85, 10.60), P=0.02; MD=5.53, 95%C/(0.68, 10.38), P=0.03); MD=5.90, 95%C/(0.87, 10.93), P=0.02j. Morphine use was less in the steroid group than in the control group [MD=-7.94, 95%C/(-14.35, -1.53), P=0.02j. Hospital stay was shorter in the steroid group than in the control group [AfD=-0.98, 95%C/(-1.25, -0.71), P < 0.000 01]. Straight leg raising took less time in the steroid group than in the control group [MD=0.65, 95%C/(-0.86, 0.44), P < 0.000 01]. Postoperative C-reactive protein level was lower in the steroid group than in the control group [WMD=-4.82, 95%C/(7.41, 2.23), P=0.000 3]. Knee society score and complication rate were not significantly different between the two groups. (3) To conclude, the periarticular injection of steroid-containing cocktails after knee arthroplasty is safe and effective.

Periarticular Injection with Corticosteroid Has an Additional Pain Management Effect in Total Knee Arthroplasty

PURPOSE: Although the analgesic effects of corticosteroids have been well documented, little information is available on periarticular injection (PI) containing corticosteroids for early postoperative pain management after total knee arthroplasty (TKA). We performed a prospective double-blind randomized trial to evaluate the efficacy and safety of an intraoperative corticosteroid PI in patients undergoing TKA. MATERIALS AND METHODS: Seventy-six consecutive female patients undergoing bilateral staged TKA were randomized to receive steroid or non-steroid PI, with 3 months separating the procedures. The steroid group received PI with a mixture containing triamcinolone acetonide (40 mg). The non-steroid group received the same injection mixture without corticosteroid. During the postoperative period, nighttime pain, functional recovery [straight leg raising (SLR) ability and maximal flexion], patient satisfaction, and complications were recorded. Short-term postoperative clinical scores and patient satisfaction were evaluated at 6 months. RESULTS: The pain level was significantly lower in the PI steroid than the non-steroid group on the night of the operation (VAS, 1.2 vs. 2.3; p=0.021). Rebound pain was observed in both groups at POD1 (VAS, 3.2 vs. 3.8; p=0.248), but pain remained at a low level thereafter. No significant differences were seen in maximal flexion, frequency of acute rescuer, clinical scores, and patient satisfaction. The steroid group was able to perform SLR earlier than the non-steroid group (p=0.013). The incidence of complications was similar between the groups. CONCLUSION: PI containing a corticosteroid provided an additional pain-relieving effect on the night of the operation. In addition, corticosteroid PI did not increase the perioperative complications of TKA.

Usefulness of Morphine in the Periarticular Multimodal Drug Local Injection after Surgery for Hallux Valgus / 대한족부족관절학회지

PURPOSE: Proximal metatarsal chevron osteotomy for hallux valgus is followed by significant amount of postoperative pain. Periarticular multimodal drug local injection can be an option for pain control. This study was attempted to evaluate the efficacy of the morphine as multimodal drug and to confirm the effect of periarticular multimodal drug local injection on controlling early postoperative pain. MATERIALS AND METHODS: Between March 2012 and June 2012, 22 patients received proximal metatarsal chevron osteotomy for the correction of hallux valgus deformity. 10 patients (Group A) received periarticular injection of the test solution made with morphine, ropivacaine, ephinephrine and ketorolac. 12 patients (Group B) received periarticular injection of the test solution without morphine. The visual analog scale (VAS) was checked at 2, 4, 6, 8 hours, 1 day and 2 days each after surgery. RESULTS: The VAS score at postoperative 2 hours to 1 day between two groups showed no significant difference, but the VAS score at postoperative 2 days was significantly higher in Group A compared to the VAS score of group B. The amount of additional pain control (tramadol HCL) between two groups showed no significant difference for 3 days after surgery. CONCLUSION: Periarticular multimodal drug local injection was effective in reducing pain after hallux valgus surgery regardless of mixing with morphine.

Short Term Analgesic Effects of Intraoperative Periarticular Injection in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the clinical results of intraoperative periarticular injection for osteoarthritic patients who are treated with total knee arthroplasty (TKA). MATERIALS AND METHODS: Forty patients (2 males and 38 females) who underwent TKA under general anesthesia from January 2007 to May 2007 were enrolled in this study. We classified 20 cases to the injection group and 20 cases to the control group. For the injection group, we injected ropivacaine 40 mg, ketolocac tromethamine 2 mg, epinephrine 0.5 cc and morphine 0.8 cc to the periarticular soft tissue before inserting the prosthesis, and the same amount of saline was injected in the control group. We assessed the clinical results according to preoperative and postoperative range of motion (ROM), the visual analogue scale (VAS), and the dosage of the patient controlled anesthesia (PCA) in both groups. RESULTS: There was no significant difference in preoperative ROM and VAS between the groups (p>0.05). However, significant differences between the groups were reported for the postoperative ROM at 6 and 12 hour. In terms of the VAS, it showed significant differences between the groups at 6 and 12 hours and at the first and second days after operation. The dosage of PCA was significantly lower at postoperative 6 and 12 hours. CONCLUSION: For the patients treated with TKA, periarticular injection to the operation site is supposed to be an effective method at the early stage for recovery of the ROM, the postoperative pain control and to decrease of the PCA dosage.

Effect of Periarticular Injection on Knee Pain in Patients with Knee Osteoarthritis

OBJECTIVE: To evaluate the effects of a new periarticular injection in the patients with knee osteoarthritis. METHOD: Twenty seven patients, who had knee pain, were met criteria of knee osteoarthritis of American Rheumatology Association. Two injection sites were used: one to infrapatellar fat pad and the other to near the insertion area of popliteus. At first, 1 cc of 0.5% lidocaine was injected to both sites. If pain was not releaved above 50%, a mixture of 1 cc of 0.5% lidocaine and 10 mg of triamcinolone acetonide was injected to twenty seven patients, 46 knees. All patients were evaluated visual analogue scale (VAS), time for 10 meter walking, time for stair up and down, isometric knee strength before and after reatment. Paired student t test was done to investigate statistical significance of change of pain and function. RESULTS: Before treatment VAS, time for 10 meter walking, time for stair up and down and isometric knee strength were 6.1 +/- 2.1, 10.4 +/- 3.6, 10.8 +/- 7.1 and 34.0 +/- 11.4 respectively. After last treatment VAS, time for 10 meter walking, time for stair up and down and isometric knee strength were 3.5 +/- 2.5, 8.3 +/- 1.7, 8.2 +/- 3.6 and 38.8 12.9 respectively. The difference was stastistically significant between before and after treatment (p<0.05). CONCLUSION: The new periarticular injection is useful in treatment of patients with knee osteoarthritis.