TY - JOUR
T1 - Local infiltration analgesia for total knee arthroplasty
T2 - should ketorolac be added?
AU - Andersen, K V
AU - Nikolajsen, L
AU - Haraldsted, V
AU - Odgaard, A
AU - Søballe, K
PY - 2013/8
Y1 - 2013/8
N2 - BACKGROUND: Adequate postoperative analgesia with minimal side-effects is essential for early mobilization and recovery in patients undergoing total knee arthroplasty (TKA). High-volume local infiltration analgesia (LIA) with ropivacaine has been introduced, but effects of adjuvants are still debated. We tested the hypothesis that the addition of ketorolac to LIA significantly improves analgesia after TKA.METHODS: Sixty patients undergoing TKA were randomized to receive intraoperative LIA (ropivacaine 300 mg and epinephrine 0.5 mg) combined with either ketorolac 30 mg (ketorolac group) or saline (control group). After surgery, eight bolus doses of ropivacaine 100 mg combined with either ketorolac 15 mg (ketorolac group) or saline (control group) were administered every 6 h via an intra-articular catheter. The primary outcome was postoperative consumption of i.v. morphine patient-controlled analgesia (PCA). Secondary outcomes were time to first request of i.v. morphine PCA, pain intensity, side-effects, and readiness for hospital discharge.RESULTS: Consumption of i.v. morphine PCA was lower in the ketorolac group vs control group {0-6 h: 0 (0-0) vs 5 (0-10) mg, P<0.0001; 0-48 h: 10 (0-22.5) vs 48.75 (30-82.5) mg, P<0.0001 [median (inter-quartile range, IQR)]}. Time to first request of i.v. morphine PCA was longer in the ketorolac group vs the control group [490 (248-617) vs 223 (115-319) min, P=0.02, median (IQR)]. Early postoperative pain (<48 h) and readiness for hospital discharge were also significantly reduced in the ketorolac group.CONCLUSIONS: LIA with ketorolac results in reduced morphine consumption, reduced pain intensity, and earlier readiness for hospital discharge.
AB - BACKGROUND: Adequate postoperative analgesia with minimal side-effects is essential for early mobilization and recovery in patients undergoing total knee arthroplasty (TKA). High-volume local infiltration analgesia (LIA) with ropivacaine has been introduced, but effects of adjuvants are still debated. We tested the hypothesis that the addition of ketorolac to LIA significantly improves analgesia after TKA.METHODS: Sixty patients undergoing TKA were randomized to receive intraoperative LIA (ropivacaine 300 mg and epinephrine 0.5 mg) combined with either ketorolac 30 mg (ketorolac group) or saline (control group). After surgery, eight bolus doses of ropivacaine 100 mg combined with either ketorolac 15 mg (ketorolac group) or saline (control group) were administered every 6 h via an intra-articular catheter. The primary outcome was postoperative consumption of i.v. morphine patient-controlled analgesia (PCA). Secondary outcomes were time to first request of i.v. morphine PCA, pain intensity, side-effects, and readiness for hospital discharge.RESULTS: Consumption of i.v. morphine PCA was lower in the ketorolac group vs control group {0-6 h: 0 (0-0) vs 5 (0-10) mg, P<0.0001; 0-48 h: 10 (0-22.5) vs 48.75 (30-82.5) mg, P<0.0001 [median (inter-quartile range, IQR)]}. Time to first request of i.v. morphine PCA was longer in the ketorolac group vs the control group [490 (248-617) vs 223 (115-319) min, P=0.02, median (IQR)]. Early postoperative pain (<48 h) and readiness for hospital discharge were also significantly reduced in the ketorolac group.CONCLUSIONS: LIA with ketorolac results in reduced morphine consumption, reduced pain intensity, and earlier readiness for hospital discharge.
KW - Adrenergic alpha-1 Receptor Agonists/therapeutic use
KW - Aged
KW - Amides/therapeutic use
KW - Analgesia, Patient-Controlled/methods
KW - Analgesics, Opioid/therapeutic use
KW - Anesthetics, Local/therapeutic use
KW - Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
KW - Arthroplasty, Replacement, Knee
KW - Double-Blind Method
KW - Drug Therapy, Combination/methods
KW - Epinephrine/therapeutic use
KW - Female
KW - Humans
KW - Injections, Intra-Articular
KW - Ketorolac/therapeutic use
KW - Male
KW - Middle Aged
KW - Morphine/therapeutic use
KW - Pain Management/methods
KW - Pain Measurement/methods
KW - Pain, Postoperative/drug therapy
KW - Prospective Studies
KW - Ropivacaine
KW - Sodium Chloride/administration & dosage
KW - Treatment Outcome
U2 - 10.1093/bja/aet030
DO - 10.1093/bja/aet030
M3 - Journal article
C2 - 23514638
SN - 0007-0912
VL - 111
SP - 242
EP - 248
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 2
ER -