LAUSR

BACKGROUND Evidence on the efficacy and safety of periarticular multimodal drug injection (PMDI) in open elbow arthrolysis (OEA) is limited. This study aimed to investigate differences in postoperative pain, blood loss and range of motion (ROM) between PMDI versus no injection among patients undergoing OEA, and the presence of PMDI-related complications. METHODS This prospective, double-blind randomized controlled trial included 59 patients who underwent OEA. Patients randomly received PMDI (ropivacaine, epinephrine, ketoprofen) prior to wound closure or no injection. The primary outcomes were elbow pain over the first postoperative week at rest and during motion, measured using the visual analog scale (VAS). VAS scores were compared to attain the 20-mm threshold values for a minimum clinically important difference. Parecoxib consumption on OEA night and postoperative day (POD)1-3 and total consumption during the first postoperative week were recorded. Blood loss was recorded every 24 hours until POD3. ROM during rehabilitation was measured daily from day one to day seven post-surgery, as well as at 3-month follow-up. Medication-related side effects were recorded prospectively. RESULTS The mean VAS score showed clinically important differences between PMDI and control groups at rest on OEA night (mean difference (MD), 25 mm; p<0.001) and first three PODs with motion (POD1: MD 28 mm, p<0.001; POD2: MD 21 mm, p<0.001; POD3: MD 21 mm, p<0.001), but not in other postoperative assessments. Parecoxib consumption was lower in the PMDI group on OEA night and POD1-3. Total parecoxib consumption during the first postoperative week was lower in the PMDI group vs. control group (MD, 148 mg; p<0.001). Blood drainage was less in the PMDI group vs. control group on POD1 (MD, 38 mL; p=0.016), but not on POD2 (p=0.950), POD3 (p=0.259), or total (p=0.184). The PMDI group exhibited significantly better ROM during the first four PODs than the control group, while no difference at 3-month follow-up. No medication-related side effects were noted in the PMDI group. CONCLUSION PMDI effectively relieves pain and reduces analgesic consumption for OEA patients, without apparent increase in risks.