Effect of periarticular cocktail of analgesia on immediate post-operative clinical outcomes after bilateral simultaneous total knee arthroplasty: a randomized placebo controlled, split-body superiority trial.

Introduction: Total knee arthroplasty is the commonest procedure being done for Osteoarthritis of knee in current practice. In spite of its success many patients suffer from post-operative pain especially in the early post-operative period. The study aimed to evaluate the pain relief and functional benefit of periarticular cocktail infiltration. Methodology: Sixty-four patients undergoing simultaneous bilateral total knee were randomised to receive peri-articular cocktail injection in one knee and a similar amount of normal saline in contralateral knee. Cocktail consisted of ketorolac, ropivacaine and epinephrine. Patients' visual analog pain score (VAS), knee range of motion, quadriceps strength, single step test (SST) were recorded post-operatively. Results: The cocktail infiltrated knee had significantly lesser pain scores during the first 48 h. Intervened knee achieved better knee range of motion at 72 h and 14 days post-surgery. Quadriceps power and SST had better results in cocktail injected knees at 72 h, but no significant difference was detected at 14-day follow-up. Conclusion: Use of peri-articular cocktail injection is an effective modality to achieve better pain relief in early post-operative period. Though the benefits are not long lived, but its superior effects can be utilised for early functional recovery after TKA and improved patient rehabilitation. Level of evidence: I, Randomized Controlled Trial.