The purpose of this clinical trial was to compare degree of postoperative pain and medication utilization among knee arthroplasty patients who did and did not receive an intraarticular infusion of bupivacaine along with standard systemic analgesics. Patients 18 years and older, who were scheduled for primary total knee arthroplasty (TKA) consented to participate, were randomized into two groups. The experimental group received a bolus of 30ml of 0.25% Bupivacaine via a catheter which terminated in the capsule at the superior patella. This bolus was followed by continuous infusion of Marcaine 0.5% at 2cc per hour for the next 48 hours. The experimental and control groups were provided with the usual postoperative pain management including intravenous (IVP) Dilaudid for break through pain and scheduled doses of Oxycodone, Vioxx or Celebrex for three days. Perception of pain, pain management and side effects were collected from all subjects at days 1 and 3 postoperatively. Total amounts of pain medications administered over the 3 days were also collected. The findings indicate that randomization created similar groups with regard to age, gender, length of stay and of operative analgesia. The results indicated no differences between the groups in terms of postoperative pain, doses of Oxycodone, Vioxx or Celebrex or the amount of IVP Dilaudid administered for break through pain over the postoperative period. Both groups did exhibit similar significant declines in measures of pain over the postoperative period, while the experimental group experienced greater pain than expected and reported less satisfaction with pain management compared with the usual care condition. These findings fail to support the efficacy of intraarticular infusions of narcotics as a superior method of managing the postoperative pain among TKA patients.
Session #1065 - Pain Management: Implications for Nursing Practice
The 29th Annual MNRS Research Conference (April 1-4, 2005)