Background The routine use of postoperative drainage after total knee arthroplasty (TKA) remains controversial, particularly in the era of modern blood-saving strategies. While drains have traditionally been used to reduce hematoma formation, their effect on early postoperative pain has not been clearly established. This study aimed to evaluate whether postoperative drainage influences early pain outcomes following primary TKA. Methods An assessor-blinded randomized comparative study was conducted including 60 patients undergoing primary hybrid TKA with posterior cruciate ligament preservation. Patients were randomly allocated to a drainage or no-drainage group, with stratification by sex. All patients followed identical anesthetic, surgical, and multimodal analgesic protocols, including routine administration of tranexamic acid. Pain was assessed using the visual analogue scale (VAS) preoperatively and at 48 h postoperatively. The number of postoperative morphine rescue doses was recorded as an objective pain-related outcome. Secondary outcomes included haemoglobin level at discharge and length of hospital stay. Results No significant differences were observed between the drainage and no-drainage groups regarding postoperative VAS pain scores, morphine rescue requirements, haemoglobin levels at discharge, or length of hospital stay (all p > 0.05). In both groups, postoperative pain was significantly lower than preoperative pain ( p < 0.05). Higher body mass index was associated with greater preoperative pain but did not influence postoperative pain outcomes. Conclusion Within contemporary perioperative protocols including tranexamic acid, routine use of postoperative drainage after primary TKA does not improve early postoperative pain control or reduce opioid requirements. These findings support omitting routine drainage without compromising early pain outcomes.
Castellano-Curado et al. (Thu,) studied this question.