Ketamine and bupivacaine attenuate post‑operative pain following total knee arthroplasty: A randomized clinical trial

Zhang,Jian; Shi,Kui; Jia,Hongfeng

doi:10.3892/etm.2018.6104

Ketamine and bupivacaine attenuate post‑operative pain following total knee arthroplasty: A randomized clinical trial

Authors:
- Jian Zhang
- Kui Shi
- Hongfeng Jia
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Affiliations: Department of Anaesthesiology, Yan An Traditional Chinese Medicine, Yanan, Shanxi 716000, P.R. China, Department of Anaesthesiology, Hanzhong Hospital of Traditional Chinese Medicine, Hanzhong, Shanxi 723001, P.R. China, Department of Anaesthesiology, 3201 Hospital Affiliated to Xi'an Jiaotong University Health Science Center, Xi'An, Shanxi 723000, P.R. China
Published online on: April 27, 2018 https://doi.org/10.3892/etm.2018.6104
Pages: 5537-5543

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Abstract

Total knee arthroplasty (TKA) is highly associated with post‑operative pain. The present randomized trial aimed to explore the possible post‑operative pain management by a different combination of analgesics or opioids (ketamine and bupivacaine) following TKA. A total of 84 patients were randomly divided into four groups. All subjects were anesthetized for TKA surgery and received post‑operative pain management via intra‑articular saline (control group; n=23), ketamine (2 mg/kg) infused with saline (ket group; n=21) bupivacaine (0.5 mg/kg) infused with saline (bupi group; n=20) or ketamine (2 mg/kg)+bupivacaine (0.5 mg/kg) infused with saline (ket+bupi group; n=20) at the end of the surgery. Additional, post‑operative analgesia was infused with the aid of patient‑controlled analgesia with morphine. A reduction in the levels of pain score (verbal rating scale and visual analog scale), opioid consumption, time of ambulation, hospital stay and adverse events were observed in the ket+bupi group compared with the other groups. Meanwhile, the satisfaction score and knee flexion degree were improved following treatment with the ket+bupi regimen. Therefore, the multimodal analgesic regimen (ket+bupi) may be useful in mitigating post‑operative pain as and improving knee mobilization following TKA.

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1	Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O and Rasmussen S: A randomized, controlled trial of total knee replacement. N Engl J Med. 373:1597–606. 2015. View Article : Google Scholar : PubMed/NCBI
2	Wang CJ, Long FY, Yang LQ, Shen YJ, Guo F, Huang TF and Gao J: Efficacy of perineural dexamethasone with ropivacaine in adductor canal block for post-operative analgesia in patients undergoing total knee arthroplasty: A randomized controlled trial. Exp Ther Med. 14:3942–3496. 2017. View Article : Google Scholar : PubMed/NCBI
3	Affas F, Nygårds EB, Stiller CO, Wretenberg P and Olofsson C: Pain control after total knee arthroplasty: A randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop. 82:441–447. 2011. View Article : Google Scholar : PubMed/NCBI
4	Barrington JW, Dalury DF, Emerson RH Jr, Hawkins RJ, Joshi GP and Stulberg BN: Improving patient outcomes through advanced pain management techniques in total hip and knee arthroplasty. Am J Orthop (Belle Mead NJ). 42 10 Suppl:S1–S20. 2013.PubMed/NCBI
5	Baker PN, Van der Meulen JH, Lewsey J and Gregg PJ: National Joint Registry for England and Wales: The role of pain and function in determining patient satisfaction after total knee replacement. J Bone Joint Surg Br. 89:893–900. 2007. View Article : Google Scholar : PubMed/NCBI
6	Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A and Murthy Y: Femoral nerve block improves analgesia outcomes after total knee arthroplasty: A meta-analysis of randomized controlled trials. Anesthesiol. 113:1144–1162. 2010. View Article : Google Scholar
7	Lee JK, Chung KS and Choi CH: The effect of a single dose of preemptive pregabalin administered with COX-2 inhibitor: A trial in total knee arthroplasty. J Arthroplasty. 30:38–42. 2015. View Article : Google Scholar : PubMed/NCBI
8	Yu B, Hu X, Zou T, He M and Cai G: Effects of postoperative continuous femoral nerve block analgesia with braun continuous peripheral nerve block catheter set versus novel needle-over-cannula after total knee arthroplasty. Med Sci Monit. 21:1843–1849. 2015. View Article : Google Scholar : PubMed/NCBI
9	Lin J, Zhang L and Yang H: Perioperative administration of selective cyclooxygenase-2 inhibitors for postoperative pain management in patients after total knee arthroplasty. J Arthroplasty. 28:207–213.e2. 2013. View Article : Google Scholar : PubMed/NCBI
10	Lamplot JD, Wagner ER and Manning DW: Multimodal pain management in total knee arthroplasty: A prospective randomized controlled trial. J Arthroplasty. 29:329–34. 2014. View Article : Google Scholar : PubMed/NCBI
11	Beaupre LA, Johnston DB, Dieleman S and Tsui B: Impact of a preemptive multimodal analgesia plus femoral nerve blockade protocol on rehabilitation, hospital length of stay, and postoperative analgesia after primary total knee arthroplasty: A controlled clinical pilot study. ScientificWorldJournal. 2012:2738212012. View Article : Google Scholar : PubMed/NCBI
12	Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, et al: Management of Postoperative Pain: A clinical practice guideline from the American pain society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' committee on regional anesthesia, executive committee, and administrative council. J Pain. 17:131–157. 2016. View Article : Google Scholar : PubMed/NCBI
13	Zeidan A, Kassem R, Nahleh N, Maaliki H, El-khatib M, Struys MM and Baraka A: Intraarticular tramadol-bupivacaine combination prolongs the duration of postoperative analgesia after outpatient arthroscopic knee surgery. Anesth Analg. 107:292–299. 2008. View Article : Google Scholar : PubMed/NCBI
14	Bondok RS and El-Hady Abd AM: Intra-articular magnesium is effective for postoperative analgesia in arthroscopic knee surgery. Br J Anaesth. 97:389–392. 2006. View Article : Google Scholar : PubMed/NCBI
15	Jouguelet-Lacoste J, La Colla L, Schilling D and Chelly JE: The use of intravenous infusion or single dose of low-dose ketamine for postoperative analgesia: A review of the current literature. Pain Med. 16:383–403. 2015. View Article : Google Scholar : PubMed/NCBI
16	Zhang Y, Lin H and Yi WB: Evaluation of the effects of ketamine on spinal anesthesia with levobupivacaine or ropivacaine. Exp Ther Med. 12:2290–2296. 2016. View Article : Google Scholar : PubMed/NCBI
17	Adam F, Chauvin M, Manoir Du B, Langlois M, Sessler DI and Fletcher D: Small dose ketamine improves postoperative analgesia and rehabilitation after total knee arthroplasty. Anesth Analg. 100:475–480. 2005. View Article : Google Scholar : PubMed/NCBI
18	Sun QB, Liu SD, Meng QJ, Qu HZ and Zhang Z: Single administration of intra-articular bupivacaine in arthroscopic knee surgery: A systematic review and meta-analysis. BMC Musculoskelet Disord. 16:212015. View Article : Google Scholar : PubMed/NCBI
19	Batra YK, Mahajan R, Bangalia SK, Nagi ON and Dhillon MS: Bupivacaine/ketamine is superior to intra-articular ketamine analgesia following arthroscopic knee surgery. Can J Anesth. 52:832–836. 2005. View Article : Google Scholar : PubMed/NCBI
20	Yu S, Szulc A, Walton S, Bosco J and Iorio R: Pain control and functional milestones in total knee arthroplasty: Liposomal bupivacaine versus femoral nerve block. Clin Orthop Relat Res. 475:110–117. 2017. View Article : Google Scholar : PubMed/NCBI
21	Inanoglu K, Akkurt Ozbakis BC, Turhanoglu S, Okuyucu S and Akoglu E: Intravenous ketamine and local bupivacaine infiltration are effective as part of a multimodal regime for reducing post-tonsillectomy pain. Med Sci Monit. 15:CR539–CR543. 2009.PubMed/NCBI
22	Kellgren JH and Lawrence JS: Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 16:494–502. 1957. View Article : Google Scholar : PubMed/NCBI
23	Surdam JW, Licini DJ, Baynes NT and Arce BR: The use of exparel (liposomal bupivacaine) to manage postoperative pain in unilateral total knee arthroplasty patients. J Arthroplasty. 30:325–329. 2015. View Article : Google Scholar : PubMed/NCBI
24	Ferreira-Valente MA, Pais-Ribeiro JL and Jensen MP: Validity of four pain intensity rating scales. Pain. 152:2399–2404. 2011. View Article : Google Scholar : PubMed/NCBI
25	Li M, Li L, Xu YT and Wang X: Intravenous analgesics for pain management in postoperative patients: a comparative study of their efficacy and adverse effects. Trop J Pharma Res. 15:1799–806. 2016. View Article : Google Scholar
26	Matassi F, Duerinckx J, Vandenneucker H and Bellemans J: Range of motion after total knee arthroplasty: The effect of a preoperative home exercise program. Knee Surg Sports Traumatol Arthrosc. 22:703–709. 2014. View Article : Google Scholar : PubMed/NCBI
27	Tali M and Maaroos J: Lower limbs function and pain relationships after unilateral total knee arthroplasty. Int J Rehab Res. 33:264–267. 2010. View Article : Google Scholar
28	American Society of Anesthesiologists Task Force on Acute Pain Management: Practice guidelines for acute pain management in the perioperative setting: An updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 116:248–273. 2012. View Article : Google Scholar : PubMed/NCBI
29	Ritter MA, Koehler M, Keating EM, Faris PM and Meding JB: Intra-articular morphine and/or bupivacaine after total knee replacement. J Bone Joint Surg Br. 81:301–303. 1999. View Article : Google Scholar : PubMed/NCBI
30	Lombardi AV Jr, Berend KR, Mallory TH, Dodds KL and Adams JB: Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res. 428:125–30. 2004. View Article : Google Scholar
31	Laskowski K, Stirling A, McKay WP and Lim HJ: A systematic review of intravenous ketamine for postoperative analgesia. Can J Anesth. 58:911–923. 2011. View Article : Google Scholar : PubMed/NCBI
32	Elia N and Tramer MR: Ketamine and postoperative pain-a quantitative systematic review of randomized trials. Pain. 113:61–70. 2005. View Article : Google Scholar : PubMed/NCBI
33	Himmelseher S and Durieux ME: Ketamine for perioperative pain management. Anesthesiology: J Am Soc Anesthesiol. 102:211–20. 2005. View Article : Google Scholar
34	Menigaux C, Guignard B, Fletcher D, Sessler DI, Dupont X and Chauvin M: Intraoperative small-dose ketamine enhances analgesia after outpatient knee arthroscopy. Anesth Analg. 93:606–612. 2001. View Article : Google Scholar : PubMed/NCBI
35	Isharnouby NM, Eid HE, Elezz Abou NF and Moharram AN: Intraarticular injection of magnesium sulphate and/or bupivacaine for postoperative analgesia after arthroscopic knee surgery. Anesth Analg. 106:1548–1552. 2008. View Article : Google Scholar : PubMed/NCBI
36	Wu CT, Yeh CC, Yu JC, Lee MM, Tao PL, Ho ST and Wong CS: Pre-incisional epidural ketamine, morphine and bupivacaine combined with epidural and general anaesthesia provides pre-emptive analgesia for upper abdominal surgery. Acta Anaesthesiol Scand. 44:63–68. 2000. View Article : Google Scholar : PubMed/NCBI