Different “cocktail” protocol on early pain control after total knee arthroplasty

doi:10.3877/ cma.j.issn.1674-134X.2025.01.006

Abstract

Abstract:

Objective

To explore the effect of different protocol “cocktail” on early pain control after total knee arthroplasty.

Methods

A total of 114 patients undergoing total knee arthroplasty for osteoarthritis in Shenzhen People's Hospital from January 2023 to June 2024 were enrolled, and the patients with bilateral concurrent replacement were excluded.The patients were divided into four groups according to the intraoperative cocktail formula and administration routes: with morphine + intra-articular perfusion group(morphine perfusion group); with morphine + periarticular injection group (morphine injection group); without morphine + intra-articular perfusion group (perfusion group); without morphine + peri-articular injection group(injection group).Analysis of variance (ANOVA) was used to analyze the intraoperative “cocktail” operation time,visual analog scale (VAS) at 24 h and 72 h after surgery, knee joint range of motion (ROM) at 24 h and 72 h after surgery, the proportion of additional analgesic drugs at 72 h after surgery and the occurrence of adverse reactions at 72 h after surgery were analyzed by chi square test.

Results

There was no statistically significant difference inVAS score at 24 h and 72 h after surgery (F=0.363, 0.474), ROM of knee joint at 24 h and 72 h after surgery (F=0.719, 1.606), and the proportion of additional analgesics administered within 72 h (χ²=0.259)(all P>0.05) However, intra-articular perfusion “cocktail” took significantly less operative time (9.5±1.8) s than periarticular injection (41.2±4.9) s (t=-47.60, P<0.01).The overall incidence of adverse reactions within 72 h after surgery was significantly lower in the two groups without morphine than in the two groups with morphine(χ²=8.961, P=0.027), The main manifestations were nausea and vomiting (χ²=7.917, P=0.046).There was no statistically significant difference in incidence of urinary storage, deep vein thrombosis (DVT) or peripheral nerve injury (P>0.05).

Conclusion

Intra-articular perfusion without morphine ＂cocktail＂, which is not only effective for early pain control after TKA, but also has shorter intraoperative operation time and lower incidence of early postoperative complications, is worthy of clinical promotion.

Key words: Perfusion, Morphine, Arthroplasty, relacement, knee

Tiancheng Zhang, Lijie Wang, Pengyu Gao, Wangxing Liu, Wei Jiang. Different “cocktail” protocol on early pain control after total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(01): 34-38.

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URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/ cma.j.issn.1674-134X.2025.01.006

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2025/V19/I01/34

Figures/Tables 3

Table 1 General preoperative data of 4 groups

组别Groups	例数Number of cases	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age(year)	男性/女性Male/Female	左侧/右侧Left/Right	BMI［kg/m²，（ $\overset{ˉ}{x}$ ±s）］	K-L分级Ⅲ /Ⅳ
吗啡灌注组Morphine perfusion group	32	70±7	7/25	18/14	26±3	8/24
吗啡注射组Morphine injection group	27	68±8	5/22	10/17	26±4	6/21
灌注组Perfusion group	29	70±6	6/23	13/16	26±4	11/18
注射组Injection group	26	71±9	2/24	12/14	27±4	10/16
统计值Statistical values		F=0. 722	χ ²=2. 375	χ ²=2. 229	F=0. 280	χ ²=2. 850
P值		>0. 05	>0. 05	>0. 05	>0. 05	>0. 05

Table 1 General preoperative data of 4 groups

组别Groups	例数Number of cases	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age(year)	男性/女性Male/Female	左侧/右侧Left/Right	BMI［kg/m²，（ $\overset{ˉ}{x}$ ±s）］	K-L分级Ⅲ /Ⅳ
吗啡灌注组Morphine perfusion group	32	70±7	7/25	18/14	26±3	8/24
吗啡注射组Morphine injection group	27	68±8	5/22	10/17	26±4	6/21
灌注组Perfusion group	29	70±6	6/23	13/16	26±4	11/18
注射组Injection group	26	71±9	2/24	12/14	27±4	10/16
统计值Statistical values		F=0. 722	χ ²=2. 375	χ ²=2. 229	F=0. 280	χ ²=2. 850
P值		>0. 05	>0. 05	>0. 05	>0. 05	>0. 05

Table 2 The data of postoperative VAS, ROM and the proportion of additional analgesic drugs in 4 groups

组别Groups	例数Number of cases	VAS （ $\overset{ˉ}{x}$ ±s）		ROM （ $\overset{ˉ}{x}$ ±s）		追加止痛药物比例（例）Proportion of additional analgesics
组别Groups	例数Number of cases	24 h	72 h	24 h	72 h	追加止痛药物比例（例）Proportion of additional analgesics
吗啡灌注组Morphine perfusion group	32	3. 5±0. 7	3. 0±0. 4	88. 4±5. 1	103. 6±7. 6	10/32
吗啡注射组Morphine injection group	27	3. 7±0. 6	2. 8±0. 5	86. 7±8. 2	100. 9±8. 4	7/27
灌注组Perfusion group	29	3. 5±0. 7	2. 9±0. 5	89. 0±5. 7	105. 3±7. 3	9/29
注射组Injection group	26	3. 5±0. 6	3. 0±0. 5	88. 7±6. 3	104. 4±8. 2	8/26
统计值Statistical values		F=0. 363	F=0. 474	F=0. 719	F=1. 606	χ ²=0. 259
P值		>0. 05	>0. 05	>0. 05	>0. 05	>0. 05

Table 2 The data of postoperative VAS, ROM and the proportion of additional analgesic drugs in 4 groups

组别Groups	例数Number of cases	VAS （ $\overset{ˉ}{x}$ ±s）		ROM （ $\overset{ˉ}{x}$ ±s）		追加止痛药物比例（例）Proportion of additional analgesics
组别Groups	例数Number of cases	24 h	72 h	24 h	72 h	追加止痛药物比例（例）Proportion of additional analgesics
吗啡灌注组Morphine perfusion group	32	3. 5±0. 7	3. 0±0. 4	88. 4±5. 1	103. 6±7. 6	10/32
吗啡注射组Morphine injection group	27	3. 7±0. 6	2. 8±0. 5	86. 7±8. 2	100. 9±8. 4	7/27
灌注组Perfusion group	29	3. 5±0. 7	2. 9±0. 5	89. 0±5. 7	105. 3±7. 3	9/29
注射组Injection group	26	3. 5±0. 6	3. 0±0. 5	88. 7±6. 3	104. 4±8. 2	8/26
统计值Statistical values		F=0. 363	F=0. 474	F=0. 719	F=1. 606	χ ²=0. 259
P值		>0. 05	>0. 05	>0. 05	>0. 05	>0. 05

Table 3 Comparative analysis of the occurrence of adverse reactions in the early postoperative period (within 72 h) in 4 groups［n (%)］

组别Groups	例数Number of cases	总体发生率Overall incidence	恶心呕吐Nausea and vomiting	尿潴留Urinary storage
吗啡灌注组Morphine perfusion group	32	12(31. 3)	9(28. 1)	3(9. 4)
吗啡注射组Morphine injection group	27	10(37. 0)	10(37. 0)	2(7. 4)
灌注组Perfusion group	29	4(13. 8)	3(10. 3)	1(3. 5)
注射组Injection group	26	3(11. 5)	3(11. 5)	0(0)
χ ² 值		8. 961	7. 917	2. 765
P值		0. 027	0. 046	>0. 05

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