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A new solution to control pain after knee replacement surgery

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In a recently available study, Houston Methodist researchers presented clinical evidence supporting the safety and efficacy of injecting pain medication straight into the tibia during knee replacement surgery for better postoperative pain management.

The double-blind, randomized trial detailed in The Journal of Arthroplasty revealed that patients finding a combination of morphine and the antibiotic vancomycin injected in to the tibia (additionally referred to as the ) of these knee joint have less post-surgery in comparison to those that received the infusion without morphine during surgery.

“Despite many technological advances, controlling pain after could be challenging; most patients experience considerable discomfort and pain, especially in the initial little while to their recovery,” said Kwan “Kevin” Park, M.D., at Houston Methodist. “Intraosseous infusion, that involves injecting medication straight into the bone marrow, we can control pain pre-emptively in order that patients need not take just as much pain medicine down the road.”

Total knee replacement may be the recommended treatment to ease due to harm to the knee joint from arthritis or injury. In accordance with the 2021 American Joint Replacement Registry Annual Report, primary knee replacement surgeries accounted for 54.5% of the nearly two million hip and knee replacement procedures performed between 2012 and 2020.

Regardless of the high frequency and favorable outcomes of the medical procedure, the manipulation of soft tissue and resurfacing damaged bones during knee replacement distress in the first postoperative periods.

“Two decades ago, patients would stay in the hospital for many days after their surgery and receive extremely high-dose narcotics to greatly help making use of their postoperative pain,” Park said. “But there’s been a ; patients tend to be discharged exactly the same day after , and we use multimodal pain management techniques that work far better for and require fewer narcotics.”

These multimodal regimens, he added, often add a mix of medications, such as for example nonsteroidal anti-inflammatory drugs, opioids and neurogenic agents that act on the nervous system, administered both pre-emptively and following the surgery. However, opioid medications, although very effective in managing pain, have known unwanted effects, like constipation and nausea, plus some folks are allergic to opiates. Opioid medication could be highly addictive, aswell. Furthermore, a consensus on the perfect preoperative protocol to mitigate pain is lacking.

Previously, the researchers demonstrated that injecting the antibiotic vancomycin straight into the tibia before surgery helped in reducing infection by reaching an increased concentration of the drug in the knee. Motivated by this success, they investigated whether adding morphine in to the tibial bone with a typical antibiotic solution could improve postoperative pain management.

For the analysis, the team included 48 patients needing total knee replacement surgery. Of the patients, half were randomly assigned to get vancomycin and morphine injected straight into the bone marrow, utilizing an infusion device that has been inserted in to the tibial tubercle region. The rest of the were only administered vancomycin. Post-surgery, the researchers monitored patient-reported pain, nausea and opioid use for 14 days after surgery. Park’s team collaborated with Francesca Taraballi, Ph.D., assistant professor of orthopedic surgery and director of Houston Methodist’s Center for Musculoskeletal Regeneration, to gauge the serum degrees of morphine and an inflammatory marker called interleukin-6 in every study participants for 10 hours following the operation.

Upon analyzing their data, the researchers discovered that the patients who have been given morphine in the tibial bone had lower pain scores after their knee replacements in comparison to those who didn’t. This is effective around fourteen days after surgery. Further, these patients also reported having less pain for a number of days despite the fact that that they had similar interleukin-6 inflammatory marker levels because the control group. Taken together, even though patients who received pain medication infused straight into the tibia during surgery had comparable inflammation, these patients were taking less pain medication post-surgery.

Park noted that infusion of opiates straight into the during surgery may potentially even facilitate a swifter recovery of the knee joint.

“By infusing intraosseously we’re in a position to reduce postoperative pain for two weeks, decrease the amount of pain pills need and also possibly enhance the function of the knee as time passes,” he said. “Our technique can also enhance the multimodal pain management protocol we’ve been using for replacement through the years.”



More info: Ava A. Brozovich et al, Intraosseous Morphine Decreases Postoperative Pain and Pain Medication Used in Total Knee Arthroplasty: A Double-Blind, Randomized Controlled Trial, The Journal of Arthroplasty (2022). DOI: 10.1016/j.arth.2021.10.009

Citation: A fresh solution to control pain after knee replacement surgery (2022, August 12) retrieved 14 August 2022 from https://medicalxpress.com/news/2022-08-pain-knee-surgery.html

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