An effective postoperative analgesia following total knee arthroplasty (TKA) would shorten the rehabilitation period and improve patient satisfaction. The primary objective of the present study is to test the hypothesis that intraoperative multimodal cocktail injection can significantly reduce the consumption of analgesics and duration of time required to perform straight-leg raise, and improve range of motion (ROM) and patient satisfaction rate following TKA.

A total of 126 osteoarthritic knees in patients with a mean age of 68 years (58–80 years) scheduled for primary TKA were prospectively randomized into three groups. Patients in all three groups received the same anesthesia and postprocedure pain control and rehabilitation protocol. The assessor was blind with regard to multimodal cocktail injection for the duration of study. Assessment was done preoperatively at 1, 2, 3, and 4 postoperative days, and at 1, 2, and 3 months postoperatively. The primary outcome was function measured with Western Ontario and McMaster Universities Arthritis Index. Pain and patient satisfaction rate were established using visual analog scale and Likert scale respectively. Consumption of analgesic during the postoperative days (1–4 days), hospital stay, and ROM were recorded and evaluated. Outcome measures were critically analyzed. The level of significance was set at <0.05.

Pain, functional scores, and satisfaction rates were significantly better in cocktail group than in the control group (p < 0.05). Consumption of nonsteroidal anti-inflammatory drugs was significantly lower in groups with multimodal cocktail injection than in the control group (p < 0.05). Mean follow-up time was 3 months with no patient lost to follow-up. No complications related to the infiltration of the local anesthetic and/or steroids were observed.

Multimodal cocktail injection offered improved postoperative pain control, thus facilitating early rehabilitation.

Shah VI, Upadhyay S, Shah K, Sheth AN, Kshatriya A, Saini D. Multimodal Cocktail Injection relieves Postoperative Pain and improves Early Rehabilitation following Total Knee Replacement: A Prospective, Blinded and Randomized Study. J Recent Adv Pain 2017;3(1):14-24.