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bupivacaine + epinephrine + morphine + methylprednisolone + cefazolin
- Development stage
- Unknown
- Lead developer
- Hospital for Special Surgery
- Modality
- Small Molecules
- Administration
- Periarticular Injection
01
Overview
This multimodal periarticular injection (PAI) cocktail was developed and evaluated by the Hospital for Special Surgery (HSS) for the management of postoperative pain in patients undergoing primary total knee arthroplasty (TKA). The cocktail typically consists of bupivacaine (a local anesthetic sodium channel blocker), epinephrine (a vasoconstrictor to prolong local effect), morphine (an opioid analgesic), methylprednisolone (a corticosteroid anti-inflammatory), and cefazolin (an antibiotic for surgical prophylaxis). In clinical trials, it is administered as a local infiltration to supplement regional nerve blocks like the adductor canal block (ACB) and infiltration between the popliteal artery and capsule of the knee (IPACK) to further reduce pain scores and opioid consumption.
- Other names
- PAI cocktailPeriarticular Injection cocktailHSS PAI cocktail
02
Targets
ADRA1A (α1A)GR (Glucocorticoid receptor)PBP (Penicillin-binding protein family)NaV (Voltage-gated sodium channels)MOR (Mu opioid receptor)
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