Highlights
- •Multimodal pain injections for tibial plateau fractures appears to have some benefit for post-operative pain control.
- •The use of gel-foam sponges in traumatize soft tissue may not be safe and lead to infection.
- •The use of periarticular multimodal analgesic injections should be further studied in other fractures throughout the musculoskeletal system to determine their benefits.
Abstract
Introduction
The use of periarticular multimodal analgesia injections is increasing and has become
commonplace in some surgeries. However, there is no data on the effectiveness of local
periarticular multimodal analgesia for tibial plateau fractures. We hypothesized that
closed tibial plateau fracture patients receiving the local multimodal analgesic medications
would experience a decrease in VAS pain scores.
Methods
Patients aged between 18 and 79 with an isolated closed tibial plateau fracture (AO
41-B and C) were prospectively enrolled and randomized in a 1:1 double blinded fashion
to either a placebo or active medication treatment arm. After ORIF, gel-foam sponges
soaked in either multimodal analgesic solution or normal saline. Patients were followed
for 24 h post-operatively with Visual Analog pain Scores (VAS). Patients were monitored
post-operatively for complications including compartment syndrome, infection, and
non-union.
Results
The planned study was terminated prior to completion due to higher than anticipated
rates of infection (18%), distributed equally among active (3) and placebo (2) groups,
raising concerns that this may have been due to the presence of the delivery device.
Twenty-eight patients were enrolled, 15 in the active group and 13 in the placebo
group. Patients in the active medication group had significantly decreased pain scores
at hours 4 (p = 0.005, 4.2 vs 6.9), 8 (p = 0.05, 5 vs 7), and 12 (p = 0.02, 3.8 vs 6.2). Pain scores at hours 16 (p = 0.10, 4.5 vs 6.5), 20 (p = 0.08, 4.6 vs 6.4), and 24 (p = 0.10, 4.8 vs 6.5) were also decreased but did not reach significance.
Discussion
The use of local multimodal periarticular analgesic for closed tibial plateau fractures
appears to be beneficial for short-term pain control post-operatively. Concerns regarding
an implantable delivery vehicle leading to infection has warranted a change in method
of drug administration. Completion of the full study will permit us to validate or
refute these findings.
Level of Evidence
Therapeutic Level 1
Keywords
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Article Info
Publication History
Published online: September 28, 2022
Accepted:
September 25,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
