Evaluation of early effectiveness of local infiltration anesthesia with compound betamethasone in total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHENG Yuhang ^1,2 ,  LI Yang ^1,2 , TIAN Hua ^1,2

1. Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, P. R. China;
2. Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, P. R. China;

Corresponding author：

LI Yang, Email: liyangdr@bjmu.edu.cn

Keywords：

Total knee arthroplasty; local infiltration analgesia; compound betamethasone; range of motion

DOI：

10.7507/1002-1892.202309081

Video：

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Objective To evaluate the early effectiveness of local infiltration anesthesia (LIA) with compound betamethasone in total knee arthroplasty (TKA). Methods The clinical data of 102 patients with knee osteoarthritis who were treated by TKA and met the selection criteria between May 2022 and March 2023 were retrospectively analyzed. They were divided into control group and study group according to whether LIA preparation was added with compound betamethasone, with 51 cases in each group. There was no significant difference of baseline data, such as age, gender, body mass index, operative side, preoperative range of motion (ROM), Knee Society Score (KSS), white blood cell (WBC), and hematocrit between the two groups (P>0.05). The intraoperative total blood loss and hidden blood loss were recorded, and WBC was recorded on the 1st, 2nd, and 3rd days after operation. Pain was assessed by visual analogue scale (VAS) score on the 1st, 2nd, and 3rd days after operation and morphine intake milligrames equivalent within 48 hours after operation. Passive ROM, maximum extension and flexion angles of knee joint were measured on the 3rd day after operation; the early postoperative complications were recorded. Results There was no significant difference in total blood loss and hidden blood loss between the two groups (P>0.05). The postoperative pain levels in both groups were relatively mild, and there was no significant difference in VAS scores in the first 3 days after operation and in morphine intake milligrams equivalent within 48 hours after operation between the two groups (P>0.05). The WBC in the first 3 days after operation was significantly improved in both groups (P<0.05). The WBC in the study group was significantly higher than that in the control group on the 1st and 2nd days after operation (P<0.05), but there was no significant difference between the two groups on the 3rd day after operation (P>0.05). On the 3rd day after operation, the maximum extension angle of knee joint in the study group was smaller than that in the control group, while the maximum flexion angle and passive ROM of knee joint in the study group were larger than those in the control group, and the differences were significant (P<0.05). There were 6 cases of fever and 17 cases of deep venous thrombosis in the control group, and 1 case and 14 cases in the study group, respectively. There was no poor wound healing and periprosthetic joint infection in the two groups, and there was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion The application of compound betamethasone in LIA during TKA is a safe and optimal strategy to promote the early postoperative rehabilitation of patients.

Citation： ZHENG Yuhang, LI Yang, TIAN Hua. Evaluation of early effectiveness of local infiltration anesthesia with compound betamethasone in total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(1): 9-14. doi: 10.7507/1002-1892.202309081 Copy

1.	Jang S, Lee K, Ju JH. Recent updates of diagnosis, pathophysiology, and treatment on osteoarthritis of the knee. Int J Mol Sci, 2021, 22(5): 2619.
2.	Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA, 2021, 325(6): 568-578.
3.	Ighani Arani P, Wretenberg P, Ottosson J, et al. Pain, function, and satisfaction after total knee arthroplasty, with or without bariatric surgery. Obes Surg, 2022, 32(4): 1164-1169.
4.	Salwan A, Pisulkar GL, Taywade S, et al. A review on the efficacy of extraosseous local infiltration of multimodal drug cocktail for pain management after total knee or hip arthroplasty. Cureus, 2022, 14(10): e30451.
5.	庞少波, 郑越瑜, 侯霞, 等. 加速康复外科理念对膝关节置换围术期护理效果的影响. 国际护理学杂志, 2021, 40(9): 1690-1693.
6.	Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop, 2008, 79(2): 174-183.
7.	O’Neill A, Lirk P. Multimodal analgesia. Anesthesiol Clin, 2022, 40(3): 455-468.
8.	潘四磊, 王梅芳, 濮健峰, 等. 全膝关节置换术围手术期镇痛方法的临床研究进展. 国际麻醉学与复苏杂志, 2018, 39(7): 701-704.
9.	郑宇航, 李杨, 田华. 人工全膝关节置换术中关节周围局部浸润麻醉注射部位研究进展. 中国修复重建外科杂志, 2023, 37(4): 502-506.
10.	Li WT, Bell KL, Yayac M, et al. A postdischarge multimodal pain management cocktail following total knee arthroplasty reduces opioid consumption in the 30-day postoperative period: A group-randomized trial. J Arthroplasty, 2021, 36(1): 164-172.
11.	Hannon CP, Fillingham YA, Mason JB, et al. Corticosteroids in total joint arthroplasty: The clinical practice guidelines of the American association of hip and knee surgeons, American society of regional anesthesia and pain medicine, American academy of orthopaedic surgeons, hip society, and knee society. J Arthroplasty, 2022, 37(9): 1684-1687.
12.	Li Z, Li Z, Cheng K, et al. The efficacy and safety of glucocorticoid on periarticular infiltration analgesia in total knee arthroplasty: A systematic review and meta-analysis of randomized controlled trials. J Arthroplasty, 2021, 36(9): 3340-3350.
13.	Previtali D, Di Laura Frattura G, Filardo G, et al. Peri-operative steroids reduce pain, inflammatory response and hospitalisation length following knee arthroplasty without increased risk of acute complications: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2021, 29(1): 59-81.
14.	刘沛, 郭万首, 张启栋, 等. 倍他米松在初次单髁置换术中关节周围浸润注射的有效性及安全性评价. 中华医学杂志, 2019, 99(39): 3100-3104.
15.	Gasbjerg KS, Hägi-Pedersen D, Lunn TH, et al. Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial. BMJ, 2022, 376: e067325.
16.	Li Q, Mu G, Liu X, et al. Efficacy of additional corticosteroids to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res, 2021, 16(1): 77.
17.	Chia SK, Wernecke GC, Harris IA, et al. Peri-articular steroid injection in total knee arthroplasty: a prospective, double blinded, randomized controlled trial. J Arthroplasty, 2013, 28(4): 620-623.
18.	El-Boghdadly K, Short AJ, Gandhi R, et al. Addition of dexamethasone to local infiltration analgesia in elective total knee arthroplasty: double-blind, randomized control trial. Reg Anesth Pain Med, 2021, 46(2): 130-136.
19.	Muñoz-Leyva F, Jack JM, Bhatia A, et al. No benefits of adding dexmedetomidine, ketamine, dexamethasone, and nerve blocks to an established multimodal analgesic regimen after total knee arthroplasty. Anesthesiology, 2022, 137(4): 459-470.
20.	Hangody L, Szody R, Lukasik P, et al. Intraarticular injection of a cross-linked sodium hyaluronate combined with triamcinolone hexacetonide (cingal) to provide symptomatic relief of osteoarthritis of the knee: A randomized, double-blind, placebo-controlled multicenter clinical trial. Cartilage, 2018, 9(3): 276-283.
21.	Summers S, Mohile N, McNamara C, et al. Analgesia in total knee arthroplasty: Current pain control modalities and outcomes. J Bone Joint Surg (Am), 2020, 102(8): 719-727.
22.	Cheppalli N, Singanamala N, Choi TJ, et al. Intra-articular corticosteroid injection after total knee replacement: Is it safe? Cureus, 2021, 13(11): e19700.
23.	金稳. 鸡尾酒疗法对全髋关节置换术后切口局部炎症因子的影响. 长沙: 湖南师范大学, 2021.
24.	Peng HM, Wang W, Lin J, et al. Multimodal peri-articular injection with tranexamic acid can reduce postoperative blood loss versus intravenous tranexamic acid in total knee arthroplasty: A randomized controlled trial. J Orthop Surg Res, 2021, 16(1): 546.
25.	Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
26.	Parvizi J, Tan TL, Goswami K, et al. The 2018 definition of periprosthetic hip and knee infection: An evidence-based and validated criteria. J Arthroplasty, 2018, 33(5): 1309.e2-1314.e2.
27.	Kristek G, Radoš I, Kristek D, et al. Influence of postoperative analgesia on systemic inflammatory response and postoperative cognitive dysfunction after femoral fractures surgery: a randomized controlled trial. Reg Anesth Pain Med, 2019, 44(1): 59-68.
28.	Phillips WJ, Currier BL. Analgesic pharmacology: Ⅰ. Neurophysiology. J Am Acad Orthop Surg, 2004, 12(4): 213-220.
29.	Myles PS, Corcoran T. Benefits and risks of dexamethasone in noncardiac surgery. Anesthesiology, 2021, 135(5): 895-903.
30.	Mensah-Nyagan AG, Meyer L, Schaeffer V, et al. Evidence for a key role of steroids in the modulation of pain. Psychoneuroendocrinology, 2009, 34 Suppl 1: S169-S177.
31.	Capin JJ, Bade MJ, Jennings JM, et al. Total knee arthroplasty assessments should include strength and performance-based functional tests to complement range-of-motion and patient-reported outcome measures. Phys Ther, 2022, 102(6): pzac033.
32.	戴繁林, 李刚, 王小武, 等. 全膝关节置换术中膝关节容积率与术后早期膝关节活动度的相关性研究. 中国骨与关节损伤杂志, 2019, 34(12): 1249-1252.
33.	Isaac D, Falode T, Liu P, et al. Accelerated rehabilitation after total knee replacement. Knee, 2005, 12(5): 346-350.
34.	Af Klint E, Grundtman C, Engström M, et al. Intraarticular glucocorticoid treatment reduces inflammation in synovial cell infiltrations more efficiently than in synovial blood vessels. Arthritis Rheum, 2005, 52(12): 3880-3889.
35.	万超, 董圣杰, 姜丽敏, 等. 静脉或局部应用糖皮质激素在全膝关节置换术后的镇痛效果和安全性比较: 一项随机双盲对照研究. 中华骨与关节外科杂志, 2022, 15(4): 248-254,288.
36.	胡洁茹, 田伟强, 俞伟扬, 等. 脊柱外科手术患者使用糖皮质激素对术后外周血白细胞的影响. 中国现代应用药学, 2019, 36(12): 1533-1536.
37.	Saffar AS, Ashdown H, Gounni AS. The molecular mechanisms of glucocorticoids-mediated neutrophil survival. Curr Drug Targets, 2011, 12(4): 556-562.
38.	Ronchetti S, Ricci E, Migliorati G, et al. How glucocorticoids affect the neutrophil life. Int J Mol Sci, 2018, 19(12): 4090.
39.	王钧, 任瑞华, 何红彦, 等. PCT、CRP与应用激素后白细胞升高的关系. 国际呼吸杂志, 2016, 36(18): 1390-1393.
40.	陈熙尧, 曹力, 阿斯哈尔江·买买提依明, 等. 全膝关节置换手术前后关节液白细胞计数和多形核细胞比例的变化. 中华骨科杂志, 2022, 42(9): 587-593.
41.	刘凤花. 多模式护理在老年膝关节置换患者术后DVT预防中的应用. 中华现代护理杂志, 2020, 26(34): 4843-4846.

1. Jang S, Lee K, Ju JH. Recent updates of diagnosis, pathophysiology, and treatment on osteoarthritis of the knee. Int J Mol Sci, 2021, 22(5): 2619.
2. Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA, 2021, 325(6): 568-578.
3. Ighani Arani P, Wretenberg P, Ottosson J, et al. Pain, function, and satisfaction after total knee arthroplasty, with or without bariatric surgery. Obes Surg, 2022, 32(4): 1164-1169.
4. Salwan A, Pisulkar GL, Taywade S, et al. A review on the efficacy of extraosseous local infiltration of multimodal drug cocktail for pain management after total knee or hip arthroplasty. Cureus, 2022, 14(10): e30451.
5. 庞少波, 郑越瑜, 侯霞, 等. 加速康复外科理念对膝关节置换围术期护理效果的影响. 国际护理学杂志, 2021, 40(9): 1690-1693.
6. Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop, 2008, 79(2): 174-183.
7. O’Neill A, Lirk P. Multimodal analgesia. Anesthesiol Clin, 2022, 40(3): 455-468.
8. 潘四磊, 王梅芳, 濮健峰, 等. 全膝关节置换术围手术期镇痛方法的临床研究进展. 国际麻醉学与复苏杂志, 2018, 39(7): 701-704.
9. 郑宇航, 李杨, 田华. 人工全膝关节置换术中关节周围局部浸润麻醉注射部位研究进展. 中国修复重建外科杂志, 2023, 37(4): 502-506.
10. Li WT, Bell KL, Yayac M, et al. A postdischarge multimodal pain management cocktail following total knee arthroplasty reduces opioid consumption in the 30-day postoperative period: A group-randomized trial. J Arthroplasty, 2021, 36(1): 164-172.
11. Hannon CP, Fillingham YA, Mason JB, et al. Corticosteroids in total joint arthroplasty: The clinical practice guidelines of the American association of hip and knee surgeons, American society of regional anesthesia and pain medicine, American academy of orthopaedic surgeons, hip society, and knee society. J Arthroplasty, 2022, 37(9): 1684-1687.
12. Li Z, Li Z, Cheng K, et al. The efficacy and safety of glucocorticoid on periarticular infiltration analgesia in total knee arthroplasty: A systematic review and meta-analysis of randomized controlled trials. J Arthroplasty, 2021, 36(9): 3340-3350.
13. Previtali D, Di Laura Frattura G, Filardo G, et al. Peri-operative steroids reduce pain, inflammatory response and hospitalisation length following knee arthroplasty without increased risk of acute complications: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2021, 29(1): 59-81.
14. 刘沛, 郭万首, 张启栋, 等. 倍他米松在初次单髁置换术中关节周围浸润注射的有效性及安全性评价. 中华医学杂志, 2019, 99(39): 3100-3104.
15. Gasbjerg KS, Hägi-Pedersen D, Lunn TH, et al. Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial. BMJ, 2022, 376: e067325.
16. Li Q, Mu G, Liu X, et al. Efficacy of additional corticosteroids to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res, 2021, 16(1): 77.
17. Chia SK, Wernecke GC, Harris IA, et al. Peri-articular steroid injection in total knee arthroplasty: a prospective, double blinded, randomized controlled trial. J Arthroplasty, 2013, 28(4): 620-623.
18. El-Boghdadly K, Short AJ, Gandhi R, et al. Addition of dexamethasone to local infiltration analgesia in elective total knee arthroplasty: double-blind, randomized control trial. Reg Anesth Pain Med, 2021, 46(2): 130-136.
19. Muñoz-Leyva F, Jack JM, Bhatia A, et al. No benefits of adding dexmedetomidine, ketamine, dexamethasone, and nerve blocks to an established multimodal analgesic regimen after total knee arthroplasty. Anesthesiology, 2022, 137(4): 459-470.
20. Hangody L, Szody R, Lukasik P, et al. Intraarticular injection of a cross-linked sodium hyaluronate combined with triamcinolone hexacetonide (cingal) to provide symptomatic relief of osteoarthritis of the knee: A randomized, double-blind, placebo-controlled multicenter clinical trial. Cartilage, 2018, 9(3): 276-283.
21. Summers S, Mohile N, McNamara C, et al. Analgesia in total knee arthroplasty: Current pain control modalities and outcomes. J Bone Joint Surg (Am), 2020, 102(8): 719-727.
22. Cheppalli N, Singanamala N, Choi TJ, et al. Intra-articular corticosteroid injection after total knee replacement: Is it safe? Cureus, 2021, 13(11): e19700.
23. 金稳. 鸡尾酒疗法对全髋关节置换术后切口局部炎症因子的影响. 长沙: 湖南师范大学, 2021.
24. Peng HM, Wang W, Lin J, et al. Multimodal peri-articular injection with tranexamic acid can reduce postoperative blood loss versus intravenous tranexamic acid in total knee arthroplasty: A randomized controlled trial. J Orthop Surg Res, 2021, 16(1): 546.
25. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
26. Parvizi J, Tan TL, Goswami K, et al. The 2018 definition of periprosthetic hip and knee infection: An evidence-based and validated criteria. J Arthroplasty, 2018, 33(5): 1309.e2-1314.e2.
27. Kristek G, Radoš I, Kristek D, et al. Influence of postoperative analgesia on systemic inflammatory response and postoperative cognitive dysfunction after femoral fractures surgery: a randomized controlled trial. Reg Anesth Pain Med, 2019, 44(1): 59-68.
28. Phillips WJ, Currier BL. Analgesic pharmacology: Ⅰ. Neurophysiology. J Am Acad Orthop Surg, 2004, 12(4): 213-220.
29. Myles PS, Corcoran T. Benefits and risks of dexamethasone in noncardiac surgery. Anesthesiology, 2021, 135(5): 895-903.
30. Mensah-Nyagan AG, Meyer L, Schaeffer V, et al. Evidence for a key role of steroids in the modulation of pain. Psychoneuroendocrinology, 2009, 34 Suppl 1: S169-S177.
31. Capin JJ, Bade MJ, Jennings JM, et al. Total knee arthroplasty assessments should include strength and performance-based functional tests to complement range-of-motion and patient-reported outcome measures. Phys Ther, 2022, 102(6): pzac033.
32. 戴繁林, 李刚, 王小武, 等. 全膝关节置换术中膝关节容积率与术后早期膝关节活动度的相关性研究. 中国骨与关节损伤杂志, 2019, 34(12): 1249-1252.
33. Isaac D, Falode T, Liu P, et al. Accelerated rehabilitation after total knee replacement. Knee, 2005, 12(5): 346-350.
34. Af Klint E, Grundtman C, Engström M, et al. Intraarticular glucocorticoid treatment reduces inflammation in synovial cell infiltrations more efficiently than in synovial blood vessels. Arthritis Rheum, 2005, 52(12): 3880-3889.
35. 万超, 董圣杰, 姜丽敏, 等. 静脉或局部应用糖皮质激素在全膝关节置换术后的镇痛效果和安全性比较: 一项随机双盲对照研究. 中华骨与关节外科杂志, 2022, 15(4): 248-254,288.
36. 胡洁茹, 田伟强, 俞伟扬, 等. 脊柱外科手术患者使用糖皮质激素对术后外周血白细胞的影响. 中国现代应用药学, 2019, 36(12): 1533-1536.
37. Saffar AS, Ashdown H, Gounni AS. The molecular mechanisms of glucocorticoids-mediated neutrophil survival. Curr Drug Targets, 2011, 12(4): 556-562.
38. Ronchetti S, Ricci E, Migliorati G, et al. How glucocorticoids affect the neutrophil life. Int J Mol Sci, 2018, 19(12): 4090.
39. 王钧, 任瑞华, 何红彦, 等. PCT、CRP与应用激素后白细胞升高的关系. 国际呼吸杂志, 2016, 36(18): 1390-1393.
40. 陈熙尧, 曹力, 阿斯哈尔江·买买提依明, 等. 全膝关节置换手术前后关节液白细胞计数和多形核细胞比例的变化. 中华骨科杂志, 2022, 42(9): 587-593.
41. 刘凤花. 多模式护理在老年膝关节置换患者术后DVT预防中的应用. 中华现代护理杂志, 2020, 26(34): 4843-4846.

Chinese Journal of Reparative and Reconstructive Surgery

Evaluation of early effectiveness of local infiltration anesthesia with compound betamethasone in total knee arthroplasty

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