TKR LIA Ropivacaine vs. Morphine/Marcaine

Introduction: Pain management at post-operative TKR known as a key factor influencing rehabilitation. pain relief allows better compliance in rehabilitation reduce complication rate involved with immobilization, better ROM outcome, elevated patient satisfaction .local injection anesthetics (LIA)been described by various authors as an important factor to reduce pain at the post-operative .various drug mixtures used according surgeon decision and clinical practice.Ropivacaine replaced Bupivacaine due to cardiotoxicity.local infiltration dosage range up to 400cc .the purposes of the study is measurement pain relief with use of lower dosage of Ropivacaine.

Methods: case control study of 70 patients that undergo TKR under spinal anesthesia performed by three lead surgeons. LIA performed in each procedure with Ropivacaine or Morphine +Marcaine .patients were divided to two groups based on drug mixture: Marcaine 20cc+morphine 10cc(n=29 pt.) or Ropivacaine 1% 100cc(n=41 pt.).

vas score, hear rate and range of motion monitored before and after surgical procedure.

Statistics: descriptive statistics, univariate analysis,one way ANOVA or chi square. P-value related to alpha level 5%. Analysis performed by using SPSS vs 24.

Results: vas measurement at Morphine+ Marcaine group was not noted difference between measurements. difference was noted at the Rupivacaine group between measurements at POD 2-3. ROM was significant at both groups in comparison to rom measurement before the procedure with no difference between the two groups.

conclusions: Ropivacain consider safer than Marcaine for injection as LIA.

from our data collection patients who receive Morphine/Marcaine had less pain compared to those who treated with Ropivacaine. This finding may be explained by the difference in fluid volume injection from other adjusted dosage needed for THR,or with the advantage of Morphine. using the current protocol advantage in safety of Ropivacaine should be considered against its less effectiveness as demonstrated at this study.