Study of Efficacy of Extraosseous Local Infiltration of Multimodal Drug Cocktail for Pain Management After Total Joint Arthroplasty in Lower Limb.

Background Osteoarthritis (OA) is a chronic debilitating condition involving joints that ultimately leads to chronic pain, restricted mobility, and functional impairment of the joint. The gold standard treatment of end-stage OA is arthroplasty. Following arthroplasty surgery, patients might have excruciating pain in the postoperative period. Our study aimed to evaluate the beneficial effects of a multimodal drug cocktail in patients who underwent arthroplasty surgery concerning postoperative pain and knee range of motion during the healing period. Materials and methods In this randomised case-control study, we enrolled 32 patients, of which 16 patients had knee arthritis and underwent total knee replacement. In contrast, the other 16 patients had hip arthritis and underwent total hip replacement. Randomisation was done using simple random sampling (envelope method), and patients were divided into groups A and B accordingly. Group A consists of a postoperative pain management modality using epidural analgesia with a top-up at a 12-hour interval. Group B consists of a postoperative pain management modality using an extraosseous multimodal drug cocktail consisting of clonidine, cefuroxime, tramadol, bupivacaine, adrenaline, and normal saline in specific quantities. Visual analogue scale (VAS) was assessed post-surgery for walking and resting. Joint range of movement and walking distance were assessed post-surgery and compared between the two groups. Results A total of 32 patients who had OA and underwent total knee arthroplasty (TKA) and total hip arthroplasty (THA) were selected and divided into case and control groups of eight, each by simple random sampling (envelope method). The mean preop VAS scores for the epidural and cocktail groups were 7.88 ± 0.61 and 7.44 ± 0.62, respectively, with p = 0.057, which is insignificant. However, when the groups were compared based on VAS score while standing at 24, 48, and 72 hours, the standing VAS score was found to be significantly higher among subjects, given epidural analgesia with p-values of 0.001, 0.001, and 0.001 at 24, 48, and 72 hours, respectively, which is significant in our study. Also, postoperatively, at 24, 48, and 72 hours, the mean degree of movement was found to be significantly higher among subjects, given cocktail analgesia with p-values of 0.013, 0.001, and 0.001, respectively. Conclusion As a result of early postoperative pain alleviation, the current study concludes that multimodal pain control procedures, which combine more than two medications with distinct mechanisms of action, successfully increase patient satisfaction. A multimodal medication conjunction administered locally to patients resulted in improved functional outcomes, faster recovery, and better rehabilitation.