Perioperative analgesia and management
postoperative pain, pain, VTE, TKA, venous thromboembolism
INFILTRATED, INFILTRATING
All TKA procedures were performed by the same surgeon at our hospital. After general anesthesia was administered to the patient, the surgeon made a midline skin incision through the medial parapatellar approach and implanted a cemented prosthesis (DePuy Synthes, New Brunswick, NJ, USA). Before surgery, celecoxib (200 mg) was administered twice daily as a prophylactic analgesic. All patients received 1 g of tranexamic acid intravenously 30 min before skin incision and 3 and 6 h postoperatively. No tourniquets or drainage tubes were used.PIA was performed by the surgeon. The magnesium sulfate group received 0.2% ropivacaine, magnesium sulfate (2.5 mg/mL), dexamethasone (0.1 mg/mL), or epinephrine (2.0 μg/mL). The control group received 0.2% ropivacaine, dexamethasone (0.1 mg/mL), and epinephrine (2.0 μg/mL). The volume of the analgesic cocktail was 100 mL in both groups. All methods used in PIA were the same for both groups, except for the analgesic cocktail composition. Before implantation of the prosthesis, the cocktail (20 mL) was injected into the joint capsule posteriorly, and the cocktail (20 mL) served as an infiltrating analgesic for the lateral and medial collateral ligaments. After implantation, the quadricep and retinacular tissues were infiltrated with the cocktail (20 mL), and the subcutaneous tissues and fat were infiltrated with the cocktail (40 mL). Systemic corticosteroids were not administered.All patients were given an ice compression on their return to the ward; however, no pain pumps were used. Oral celecoxib (200 mg) was administered twice daily to control postoperative pain. If patients experienced intolerable pain, additional morphine hydrochloride (5 or 10 mg) was subcutaneously injected as rescue analgesia. To prevent venous thromboembolism (VTE), 0.2 mL of enoxaparin was administered 12 h postoperatively, with subsequent dose increases (0.4 mL per day) before discharge. After discharge, 10 mg of rivaroxaban was administered once a day for 2 weeks.