Would high-dose corticosteroid addition to multimodal cocktail periarticular injection contribute to prolonged pain control and better recovery following total knee arthroplasty?: study protocol for a randomized controlled trial

Multimodal cocktail analgesic injection in PIVD with lower limb radiculopathy - A mixed design cohart study

Background

The role of Sodium Channel Blocker and steroid is well established for pain relief in neuropathic pain by reducing inflamation and desensitization of nerve roots. Our study aims at analyzing the effectiveness of multimodal cocktail injections for redicular pain relief & functional outcome in patients with intervertebral disc herniation.

Material and method

This was a Mixed design (prospective & retrospective) cohort study; we included 113 patients between the age group of 18-70 years, diagnosed with Prolapse of intervertebral disc (PIVD) with lower limb radiculopathy with MRI finding L4-L5/L5-S1 vertebral disc involvement. Patients were injected with total 15 ml of cocktail injection in 3 divided doses at 3 identified sites in affected lower limb. . Patient was examined & evaluated clinically for VAS pain score, SLRT, Sensory, Motor Examination on day 2, day 7, day 15 & after 1 month.

Result

We found that the mean pre-VAS score was 7.83 followed by the mean VAS score on post 2 days was 1.05, post 7 days was 3.47, post 15 days was 3.9 and post 30 days was 3.81. There was a statistically significant difference in the mean VAS score (p-value<0.0001). After one month majority of patients (54.62%) had comfortable painless walk and comfortable walking distance increased up to 1 km in 45.37% of them.

Conclusion

Use of cocktail multimodal injections for radiculopathy pain suggests that this non-operative,OPD based technique could be reasonable, efficient, and safe.

The Effects of Periarticular Injection Cocktail in Postoperative Analgesia after Bilateral Unicompartmental Knee Arthroplasty

Objective

This study was conducted to compare postoperative pain and functional recovery in bilateral unicompartmental knee arthroplasty (UKA) and unilateral UKA after cocktail therapy.

Methods

A total of 240 patients who received unilateral UKA and bilateral UKA in our orthopedic department from February 2019 to April 2020 were collected. The general clinical data was recorded and compared between the two groups of subjects, and the time of postoperative landing was recorded separately for both groups. A visual analogue scale (VAS) was used to record the patients' pain at 1, 7, and 14 days postoperatively, as well as the range of motion of the affected limb at 1, 7, 14 days, and 3 months postoperatively and the hospital for special surgery (HSS) knee score of the knee at 1 month postoperatively.

Results

After cocktail injection analgesia, unilateral patients with knee surgery got off the ground and walked significantly earlier than patients with bilateral surgery, while there was no significant difference between the two groups in terms of pain at 1, 7, and 14 days after surgery, range of motion of the affected limb at 1, 7, 14 days, and 3 months after surgery, and knee HSS score at 1 month after surgery.

Conclusion

Periarticular cocktail injection significantly reduces postoperative pain in patients, and bilateral UKA surgery can be used as satisfactory as unilateral UKA in clinical practice.