Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: A case study of 325 patients

Abstract

Background We have developed a multimodal technique for the control of pain following knee and hip surgery, called "local infiltration analgesia" (LIA). It is based on systematic infiltration of a mixture of ropivacaine, ketorolac, and adrenaline into the tissues around the surgical field to achieve satisfactory pain control with little physiological disturbance. The technique allows virtually immediate mobilization and earlier discharge from hospital.Patients and methods In this open, nonrandomized case series, we used LIA to manage postoperative pain in all 325 patients presenting to our service from Jan 1, 2005 to Dec 31, 2006 for elective hip resurfacing (HRA), primary total hip replacement (THR), or primary total knee replacement arthroplasty (TKR). We recorded pain scores, mobilization times, and morphine usage for the entire group. Results Pain control was generally satisfactory (numerical rating scale pain score range 0-3). No morphine was required for postoperative pain control in two-thirds of the patients. Most patients were able to walk with assistance between 5 and 6 h after surgery and independent mobility was achieved 13-22 h after surgery. Orthostatic hypotension, nausea, and vomiting were occasionally associated with standing for the first time, but other side effects were unremarkable. 230 (71%) of the 325 patients were discharged directly home after a single overnight stay in hospital.Interpretation Local infiltration analgesia is simple, practical, safe, and effective for pain management after knee and hip surgery.

Perioperative local infiltration anesthesia with ropivacaine has no effect on postoperative pain after total hip arthroplasty

“…The LIA consisted of 150 mL ropivacaine (2 mg/mL) and 0.5 mL epinephrine (1 mg/mL), not including ketorolac, as described by Kerr and Kohan (2008). The other group received 150 mL 0.9% saline.…”

“…Kerr and Kohan (2008) reported reduced opioid requirements and reduced hospital stay with the use of LIA consisting of ropivacaine and NSAIDs. However, trials investigating the effect of ropivacaine in LIA have not determined whether ropivacaine alone gives similar improvements following THA (Lunn et al 2011, Dobie et al 2012, Zoric et al 2014).…”

“…Multimodal analgesia in THA usually includes analgesics such as opioids, gabapentin, NSAIDs, acetaminophen, glucocorticoids, and local infiltration (Kardash et al 2008, Kerr and Kohan 2008, Toms et al 2008, Fredheim et al 2011, Maund et al 2011, Zhang et al 2011). …”

“…However, trials investigating the effect of ropivacaine in LIA have not determined whether ropivacaine alone gives similar improvements following THA (Lunn et al 2011, Dobie et al 2012, Zoric et al 2014). Studies using LIA have often combined different analgesics (Kerr and Kohan 2008, Kuchalik et al 2013), and this complicates interpretation of the results regarding the extent to which ropivacaine alone contributes to the outcome.…”

“…Other studies have shown that LIA reduces the opioid consumption (Andersen et al 2007, Kerr and Kohan 2008, Busch et al 2010, Murphy et al 2012, Kuchalik et al 2013) and shortens the hospital stay after THA (Kerr and Kohan 2008, Scott et al 2012) The results are thus conflicting, and the role of LIA in THA surgery still needs to be clarified.…”