Yonsei Med J.  2014 Mar;55(2):493-498.

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

• Kwon SK
• Yang IH
• Bai SJ
• Han CD

Abstract

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.

Keyword

Corticosteroid; periarticular injection; pain; total knee arthroplasty

MeSH Terms

Adrenal Cortex Hormones
Arthroplasty*
Female
Humans
Incidence
Knee*
Leg
Methods
Pain Management*
Pain, Postoperative
Patient Satisfaction
Postoperative Period
Prospective Studies
Triamcinolone Acetonide
Adrenal Cortex Hormones
Triamcinolone Acetonide

Figure

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  Fig. 1 Subject screening flowchart. PI, periarticular injection; CHF, congestive heart failure; GI, gastrointestinal; TKA, total knee arthroplasty.

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  Fig. 2 Summary of nighttime pain levels (bar graph) and patient satisfaction (line graph). OP night, operation night; POD1, 2, 3, and 7; 1, 2, 3, and 7 days postoperatively. *Indicates significance (p<0.05; 95% confidence intervals). VAS, Visual Analog Scale.

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