Enhanced post total knee replacement recovery by using intraarticular intraoperative cocktail injections

Abstract

Background: Optimizing pain relief in total knee replacement (TKR) is crucial postoperatively. Parenteral or epidural analgesia use may lead to adverse side effects and delaying early recovery. Local infiltration of analgesic cocktail can help prevent the side effects.

Objective: To assess the advantages of a specific cocktail combination in TKR patients, focusing on postoperative pain relief and enhanced recovery of knee mobility.

Methods: This prospective, double-blinded, placebo-controlled study was conducted at Akbar Niazi Teaching Hospital, Islamabad, from January 2022 to December 2024. Sixty consecutive patients underwent unilateral TKR were enrolled, with 30 receiving an intraoperative intraarticular cocktail injection (intervention) and 30 receiving normal saline (control). Postoperative pain for each knee was assessed using visual analog scale (VAS), and time required to attain 90° of knee flexion was recorded for both groups.

Results: The patients were between 55 and 85 years old (mean was 63.2±9.2 years), and males were 66.7%. Patients who received the cocktail injection experienced significantly less pain than the control group during the first 48 hours and achieved 90° of knee flexion in a significantly shorter time.

Conclusion: Intraoperative intraarticular cocktail injection significantly alleviates early postoperative pain and enhances early knee mobility.