Managing Postop TKA Pain with Periarticular Injections

    As part of a multimedia pain management protocol, intraoperative periarticular injection of anesthetic and analgesic agents is one of the newer modalities for controlling pain after total knee arthroplasty (TKA).

    Most joint replacement surgeons have a favorite “cocktail” of drugs they use for these injections. None of these injectable drug combinations has emerged as clearly superior to another; most, in fact, provide good pain relief with reduction in narcotic consumption following surgery.

    Researchers from the University of Louisville in Kentucky recently compared one such combination – a modified Ranawat solution of ropivacaine, epinephrine, ketorolac, and clonidine – with liposomal bupivacaine, a relatively new long-acting anesthetic agent. Preoperative teaching, implant type, and postoperative management were the same for both groups.

    Their results were similar to what other investigators have found when comparing periarticular injection drugs: Both provided similar pain relief, and patients had similar narcotic usage and knee range of motion following surgery.

    Patients who received liposomal bupivacaine injection walked a greater distance at 24, 48, and 72 hours after surgery, and more of them were discharged home instead of a rehabilitation surgery. Neither trend was significant, however.

    We asked Philip N. Collis, MD, lead author of the study, to discuss the methodology and findings of this research. Click the image above to hear his comments.


    Collis PN, Hunter A, Vaughn D, et al. Periarticular Injection Following TKA Using Liposomal Bupivacaine vs. a Modified Ranawat Suspension. A Prospective, Randomized Study (Paper 002). Presented at the Mid-America Orthopaedic Association Annual Meeting, April 22-25, 2015, Hilton Head Island, South Carolina.