Comparing Periarticular Ropivacaine Cocktail Infiltration vs Postoperative Epidural Bupivacaine for Analgesia in Primary Total Knee Arthroplasty: A Prospective Study

Background: Achieving satisfactory pain control following total knee arthroplasty (TKA) is a cornerstone of perioperative care, enabling prompt ambulation, participation in physical therapy, and restoration of joint function.Various analgesic modalities are employed in this context, including neuraxial techniques and periarticular infiltration.Among these, ropivacaine-based local infiltration analgesia (LIA) has garnered growing clinical interest owing to its straightforward application and a more favorable systemic safety profile compared to neuraxial approaches.Aim: This investigation sought to evaluate and contrast the analgesic efficacy of intraoperative periarticular ropivacaine cocktail infiltration against postoperative epidural bupivacaine infusion in individuals undergoing primary TKA.Materials and methods: A prospective, parallel-group comparative investigation was undertaken among patients scheduled for primary TKA at RajaRajeswari Medical College and Hospital, Bengaluru.Participants were assigned to one of two treatment arms: Group A, receiving intraoperative periarticular infiltration with a ropivacaine-based cocktail, and group B, receiving postoperative epidural bupivacaine analgesia.The primary outcome was pain intensity, quantified through the visual analog scale (VAS).Secondary endpoints encompassed knee joint range of motion, time elapsed before first ambulation, demand for supplemental analgesics, and postoperative adverse events.Results: Participants allocated to the ropivacaine infiltration arm recorded significantly reduced pain intensity scores during the immediate postoperative window and achieved earlier functional mobilization relative to their epidural counterparts.Moreover, the frequency of systemic adverse events was notably diminished within the infiltration group.Conclusion: Periarticular infiltration with a ropivacaine cocktail constitutes a clinically effective and well-tolerated approach to postoperative analgesia in primary TKA, and may confer advantages over epidural bupivacaine in terms of early functional recovery.