ketorolac + ropivacaine + epinephrine + methylprednisolone

PAI + steroid (Walter Reed formulation) is a multimodal analgesic combination administered via periarticular injection during total knee arthroplasty (TKA) to manage postoperative pain. The formulation consists of the local anesthetic ropivacaine, the non-steroidal anti-inflammatory drug (NSAID) ketorolac, the vasoconstrictor epinephrine, and the corticosteroid methylprednisolone. Ropivacaine provides regional anesthesia by blocking voltage-gated sodium channels, while ketorolac reduces inflammatory pain by inhibiting cyclooxygenase (COX) enzymes. Epinephrine is included to induce local vasoconstriction, thereby prolonging the duration of the anesthetic effect and reducing systemic absorption. The addition of methylprednisolone, a potent glucocorticoid, aims to further suppress local inflammation and peripheral sensitization. This specific combination is being studied by the Walter Reed National Military Medical Center to evaluate its efficacy and safety compared to standard injections alone or injections containing extended-release triamcinolone (Zilretta), particularly in patients with glycemic concerns such as diabetes.

Other names

Periarticular injection with methylprednisolone