Effect of local anaesthetic wound infiltration on acute pain and bleeding after primary total hip arthroplasty: the EDIPO randomised controlled study

Abstract

Operative wound infiltration of LIA reduced acute pain after primary THA but did not improve recovery or influence per- and postoperative bleeding.

The efficacy of periarticular drug infiltration for postoperative pain after total hip arthroplasty

“…One patient in the PDI group had a deep vein thrombosis postoperatively. Four studies [10,12,13,16] had not found the complications of infection, wound complication, and nausea, and just reported that there was no significant difference between the 2 groups about the complications. One study [10] also reported the loss of blood between the 2 groups, but no obvious difference was found.…”

“…Murphy et al [8] reported less morphine use for patients with THA who received local infiltration of an anesthetic (bupivacaine), saline. In the most recent randomized, double-blind study, Villatte et al [10] found the local infiltration technique provided effective pain relief for patients who received postoperative periarticular infiltration of THA with a local anesthetic (ropivacaine), adrenaline, but no effect on recovery and blood loss after surgery. Whereas Busch et al [9] found that patients who had THA would need less postoperative analgesic requirements and also feel less pain when they tried to move their legs if they got the periarticular infiltration of an anesthetic including morphine, and ropivacaine, ketorolac, epinephrine.…”

“…Length of hospital stay may indicate the function recovery and also the speed of pain relief, which was a comprehensive character for the evaluation of the efficacy of local infiltration. The other 3 included studies [8,10,12] did not report the length of hospital stay or did not give the detailed data about the outcomes.…”

“…Since we analyzed the local infiltration, local wound complications should be considered, but only 1 study [9] reported that there were 3 patients who had a minor wound problem in the PDI group and 1 in the control group, but they suggested that it was caused by patients’ dressings and had nothing to do with the infiltration; other studies [10,12,13,15,16] just reported that no significant difference was found between the 2 groups. About the system complication like nausea, vomiting, and urinary retention, most of the studies [8–10,12–16] reported that no patient with the complication above in both groups was found.…”

“…According to the meta-analysis by Jiang et al, [7] periarticular multimodal drug injection should be recommended for the pain management after total knee arthroplasty (TKA) or THA, and they found that PDI group had better pain relief, less opioid consumption, larger range of motion, and lower rates of nausea and vomiting than the placebo group; no significant difference was seen in regard to the length of hospital stay between the 2 groups. However, some studies [8–10] reported that drug infiltration could result in decreased pain. Murphy et al [8] and Busch et al [9] also reported that it could reduce postoperative patient-controlled analgesia requirements.…”