Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Arthroplasty - Knee
Abstract number: 23148
PAIN MANAGEMENT AFTER JOINT REPLACEMENT
Chitranjan RANAWAT, Morteza MEFTAH
Hospital for Special Surgery, New York (UNITED STATES)
INTRODUCTION: Uncontrolled pain after total knee replacement has a deleterious
effect on recovery of function, including decreased range of motion (ROM), higher
complication rates, and poorer overall outcomes. MATERIALS AND METHODS:
From October 1, 2003 through June 30, 2004, 36 patients (52 knees) underwent total
knee replacement at our institution with an advanced postoperative pain
management protocol. Preoperatively, all patients received Vioxx, 50 mg;
Oxycodone, 20 mg; and Coumadin, 5 mg. All patients were given spinal anesthesia.
Intraoperatively, a local mixture of Marcaine. 80 mg; Depo-Medtrol, 40 mg; Morphine,
4 mg; Epinephrine, 300 mcg; Zinacef 750 mg; and clonidine, 100 mcg, was injected
into the periarticular ligamentous attachments, posterior capsule, and quadriceps
tendon arthrotomy site. Patients were followed with postoperative pain scales,
patient assessment questionnaires, and monitored for narcotic requirements.
RESULTS: During the study period, narcotic pain requirements, manipulation rates,
and the need for prolonged physical therapy were significantly reduced compared to
historical controls. Recovery of function and ROM were achieved at an earlier
period. DISCUSSION: A relationship appears to exist between acute postoperative
pain and the development of arthrofibrosis. By controlling acute pain in the critical
early postoperative period following TKR (three days), the presented pain
management protocol allowed for improved recovery of knee ROM and function with
lower rates for manipulation and prolonged rehabilitation.
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