Publication:

Periarticular injection cocktails in total knee arthroplasty: composition, dosage and Periarticular injection cocktails in total knee arthroplasty: composition, dosage and technique: a systematic review of randomized controlled trials of randomized controlled trials

Effective postoperative analgesia is essential in total knee arthroplasty (TKA) to facilitate early mobilization and reduce opioid consumption. A systematic review of 48 studies was conducted in accordance with PRISMA guidelines using PubMed, Embase and Cochrane databases from January 2000 to March 2025, of which 22 studies were included in the quantitative synthesis. Local anesthetics combined with ketorolac and epinephrine form the backbone of periarticular injection. Corticosteroids provide additional early analgesic benefit. Recent randomized controlled trials (2023-2025) support multimodal cocktails and emerging adjuvants such as magnesium sulfate and liposomal bupivacaine. Periarticular injection provides effective postoperative analgesia in total knee arthroplasty, with consistent evidence supporting multimodal regimens incorporating a long-acting local anaesthetic, ketorolac and epinephrine. Corticosteroids offer additional early benefit and structured multi-site infiltration enhances analgesic outcomes. Standardization of composition and technique remains an important area for future research.