“Despite many technological advances, controlling pain after total knee arthroplasty can be challenging; most patients experience considerable pain and discomfort, especially in the first couple of weeks into their recovery,” stated Kwan “Kevin” Park, M.D., orthopedic surgeon at Houston Methodist. “Intraosseous infusion, which involves injecting medication directly into the bone marrow, allows us to control pain pre-emptively so that patients don’t have to take as much pain medicine later on.”
Complete knee alternative is the beneficial remedy to alleviate power ache attributable to injury to the knee joint from arthritis or harm. In response to the 2021 American Joint Substitute Registry Annual Report, main knee alternative surgical procedures accounted for 54.5% of the almost two million hip and knee alternative procedures carried out between 2012 and 2020.
Regardless of the excessive frequency and favorable outcomes of the surgical process, the manipulation of sentimental tissue and resurfacing broken bones throughout knee alternative trigger ache within the early postoperative intervals.
“Twenty years ago, patients would remain in the hospital for several days after their surgery and receive extremely high-dose narcotics to help with their postoperative pain,” Park stated. “But there has been a paradigm shift; patients are often discharged the same day after knee replacement surgery, and we use multimodal pain management techniques that work much better for pain control and require fewer narcotics.”
These multimodal regimens, he added, usually embody a mix of medicines, similar to nonsteroidal anti-inflammatory medication, opioids and neurogenic brokers that act on the nervous system, administered each pre-emptively and after the surgical procedure. Nevertheless, opioid drugs, though very efficient in managing ache, have recognized negative effects, like constipation and nausea, and a few people are allergic to opiates. Opioid remedy could be extremely addictive, as properly. Moreover, a consensus on the optimum preoperative protocol to mitigate ache is missing.
Beforehand, the researchers demonstrated that injecting the antibiotic vancomycin instantly into the tibia earlier than surgical procedure helped in decreasing an infection by reaching a better focus of the drug within the knee. Motivated by this success, they investigated whether or not including morphine into the tibial bone with a normal antibiotic resolution might enhance postoperative ache administration.
For the examine, the staff included 48 sufferers needing whole knee alternative surgical procedure. Of those sufferers, half had been randomly assigned to obtain vancomycin and morphine injected instantly into the bone marrow, utilizing an infusion machine that was inserted into the tibial tubercle area. The remaining had been solely administered vancomycin. Put up-surgery, the researchers monitored patient-reported ache, nausea and opioid use for as much as 14 days after surgical procedure. Park’s staff collaborated with Francesca Taraballi, Ph.D., assistant professor of orthopedic surgical procedure and director of Houston Methodist’s Middle for Musculoskeletal Regeneration, to measure the serum ranges of morphine and an inflammatory marker referred to as interleukin-6 in all examine individuals for 10 hours after the operation.
Upon analyzing their information, the researchers discovered that the sufferers who got morphine within the tibial bone had decrease ache scores after their knee replacements in comparison with those that didn’t. This was efficient as much as two weeks after surgical procedure. Additional, these sufferers additionally reported having much less ache for a number of days regardless that that they had comparable interleukin-6 inflammatory marker ranges because the management group. Taken collectively, though the sufferers who obtained ache remedy infused instantly into the tibia throughout surgical procedure had comparable irritation, these sufferers had been taking much less ache remedy post-surgery.
Park famous that this infusion of opiates instantly into the bone marrow throughout surgical procedure might probably even facilitate a swifter restoration of the knee joint.
“By infusing pain medication intraosseously we’re able to reduce postoperative pain for up to two weeks, reduce the number of pain pills patients need and even possibly improve the function of the knee over time,” he stated. “Our technique also can improve the multimodal pain management protocol we have been using for knee replacement over the years.”