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A periarticular cocktail of ropivacaine + ketorolac tromethamine + epinephrine reduces pain, opioid use, and inflammation better than ropivacaine + morphine + compound betamethasone after UKA, with comparable safety.
For isolated unicompartmental knee osteoarthritis management, unicompartmental knee arthroplasty (UKA) is the key surgical intervention. Managing pain and inflammation right after surgery shapes how quickly patients get moving again. This study compared two periarticular analgesic cocktails (pain-relief mixtures injected around the joint) to see which one worked better.
How the study was run
Clinical data from 108 patients were retrospectively screened between January 2020 and December 2024. Following strict case exclusion, 102 patients were split into two groups:
Propensity score matching was then used to balance baseline characteristics, leaving 46 patients per group, and the groups were well balanced after matching. The key endpoints were opioid consumption over 48 hours after surgery, resting and active visual analog scale (VAS) pain scores, and inflammatory biomarkers: white blood cell (WBC) count, C-reactive protein (CRP), neutrophil count, and erythrocyte sedimentation rate (ESR). The secondary endpoints were Barthel Index (BI), Knee Injury and Osteoarthritis Outcome Score (KOOS), knee range of motion (ROM), time to first ambulation after surgery, and post-surgery adverse events.
Group B pulled ahead on pain and inflammation
At 48 hours after surgery, Group B had significantly lower resting and active VAS scores and used less opioid over the same period. Rises in CRP, ESR, WBC, and neutrophil were also milder in Group B.
Faster, better knee recovery
Group B also showed good functional recovery, with shorter time to first ambulation, better knee ROM, and higher KOOS and BI scores.
Safety held steady
The incidence of adverse events did not differ significantly between the groups, indicating a noninferior safety profile for the ropivacaine-ketorolac-epinephrine cocktail.
Bottom line
Ropivacaine-ketorolac-epinephrine cocktail showed superior analgesic and anti-inflammatory powers. Given the single-center, retrospective design, the authors preliminarily considered it a valuable analgesic alternative for UKA sufferers. Large-sample studies are needed for validation.
Journal of Visualized Experiments
Comparative Effects of Two Periarticular Analgesic Cocktails on Pain Reduction and Inflammatory Response After Unicompartmental Knee Arthroplasty
Zhen Gu et al.
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