Bilateral Total Knee Arthroplasty
Conditions
Keywords
periarticular infiltration, postoperative pain management, plasma level of bupivacaine
Brief summary
To study efficacy of postoperative pain control of different concentrations of bupivacaine for periarticular infiltration, part of multimodal analgesia, in bilateral total knee arthroplasty. To study plasma concentration of bupivacaine in patient who received spinal anesthesia and single shot bilateral adductor canal block and periarticular infiltration with bupivacaine for safety level.
Detailed description
Adequate postoperative pain control reduce postoperative morbidity, multimodal analgesia techniques is used for achieve this goal. multimodal analgesia for bilateral total knee arthroplasty are peripheral nerve block, periarticular infiltration, NSAIDs, gabapentins and others. patients undergoing bilateral total knee arthroplasty in siriraj hospital receive spinal anesthesia, single shot bilateral adductor canal block and bilateral periarticular infiltration with bupivacaine so patient receive a large dose of bupivacaine. the investigators study the efficacy of postoperative pain of reduced dose of bupivacaine for periarticular infiltration. and study plasma level of bupivacaine.
Interventions
PROCEDUREbupivacaine 200 mg
bupivacaine 200 mg ketorolac 30 mg epinephrine 400 mcg add NSS to 80 ml divided to two syringes for bilateral periarticular infiltration
DRUGbupivacaine 100 mg
bupivacaine 100 mg ketorolac 30 mg epinephrine 400 mcg add NSS to 80 ml divided to two syringes for bilateral periarticular infiltration
Sponsors
Mahidol University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Aged more than 18 years old * American society of anesthesiologists physical status classification 1-3 * Undergoing bilateral total knee arthroplasty with spinal anesthesia and single shot bilateral adductor canal block
Exclusion criteria
* Allergy to bupivacaine * Body weight less than 50 kilograms * Hepatic disease * Coagulopathy * Creatinine clearance less than 60 ml/min * Uncontrolled cerebrovascular disease * Hematocrit less than 35%
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| postoperative pain score | 0-24 hours postoperative | Numerical rating scale at rest and movement in the first 24 hours postoperatively |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| plasma bupivacaine level | 40 minutes after 1st articular infiltration, 15,30,45,60,90 minutes after 2nd periarticular infiltratio | plasma bupivacaine level at 40 minutes after 1st articular infiltration, 15,30,45,60,90 minutes after 2nd periarticular infiltration |
| postoperative morphine consumption | first 24 hours and 24-48 hours postoperatively | postoperative morphine consumption at first 24 hours and 24-48 hours postoperatively |
| ambulation | 48 hours postoperatively | patient can walk with assistances within 48 hours postoperatively |
Countries
Thailand
Outcome results
None listed