Multimodal Pain Management After TKA

The pre- and postoperative medications were identical in both groups except for the percutaneous periarticular multi-drug injection at the day following TKA. We routinely performed intraoperative periarticular injection for the perioperative pain management. The multi-drug solution of the injection included methylprednisolone 40 mg (Sol Mercort; Fuji, Toyama, Japan) [1 mL] as corticosteroid, 7.5 mg/mL ropivacaine (Anapeine; AstraZeneca, Osaka, Japan) [40 mL] as local anesthetics, 10 mg/mL morphine hydrochloride hydrate (Takeda, Osaka, Japan) [0.8 mL] as opioid, 1.0 mg/mL epinephrine (Bosmin; Daiichi-Sankyo, Tokyo, Japan) [0.3 mL], and 50 mg of ketoprofen (Capisten; Kissei, Matsumoto, Japan) [2.5 mL] as non-steroidal anti-inflammatory drugs [4 (link), 5 (link)]. The solution was mixed with 15.4 mL of saline to a combined volume of 60 mL. Intravenous 50 mg of flurbiprofen axetil (Ropion; Kaken, Tokyo, Japan) was given 1 h after turning back to the hospital ward. From the day following TKA, oral 60 mg of loxoprofen (Surinofen; Aska, Tokyo, Japan) was given three times per day. Study protocol permitted 25 mg of diclofenac sodium suppository (Adefuroniczupo; Teva, Nagoya, Japan) as rescue therapy. Opioid usage was prohibited apart from the morphine hydrochloride hydrate contained in the intraoperative periarticular injection.