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

Abstract

Background and purpose — The local infiltration analgesia (LIA) technique has been widely used to reduce opioid requirements and to improve postoperative mobilization following total hip arthroplasty (THA). However, the evidence for the efficacy of LIA in THA is not yet clear. We determined whether single-shot LIA in addition to a multimodal analgesic regimen would reduce acute postoperative pain and opioid requirements after THA.Patients and methods — 116 patients undergoing primary THA under spinal anesthesia were included in this randomized, double-blind, placebo-controlled trial. All patients received oral opioid-sparing multimodal analgesia: etoricoxib, acetaminophen, and glucocorticoid. The patients were randomized to receive either 150 mL ropivacaine (2 mg/mL) and 0.5 mL epinephrine (1 mg/mL) or 150 mL 0.9% saline. Rescue analgesic consisted of morphine and oxycodone as needed. The primary endpoint was pain during mobilization in the recovery unit. Secondary endpoints were pain during mobilization on the day after surgery and total postoperative opioid requirements on the first postoperative day.Results — The levels of pain during mobilization—both in the recovery unit and on the day after surgery—and consumption of opioids on the first postoperative day were similar in the 2 groups.Interpretation — LIA did not provide any extra analgesic effect after THA over and above that from the multimodal analgesic regimen used in this study.

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

“…Meta-analysis of 5 studies [11–14,16] with 361 patients after THA demonstrated that there was no significant difference of VAS score with activity between the PDI group and control group at 8 hours (MD 0.30, 95% CI −0.31 to 0.90, P  = 0.86; Table 3), 24 hours (MD 0.10, 95% CI −0.30 to 0.51, P  = 0.90; Table 3), and 48 hours postoperatively.…”

“…Meta-analysis of 5 studies [9,11,13,14,16] with 367 patients after THA showed that the PDI group had less length of hospital stay (MD −0.47, 95% CI −0.64 to −0.29, P  < 0.00001; Table 3) than the control group.…”

“…Length of hospital stay was also an important issue for postoperative recovery. Most included studies [9,11,13–16] reported that no statistical significance of the length of hospital stay was found in the analysis. 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.…”

How effective is periarticular drug infiltration in providing pain relief and early functional outcome following total hip arthroplasty?

“…Based on the study by Hofstad et al the median pain score on mobilization on the first post operative day on a 10 point Likert scale, was about 4 (3-5). 13 Keeping the non-inferiority margin at 1.5 with alpha and beta errors at 5% and 20% respectively, the sample size needed minimum was 12 subjects in each arm. We decided to study 25 subjects in each arm.…”

Comparison of Intra-Peritoneal Instillation of Bupivacaine and Morphine Hydrochloride versus Bupivacaine and Magnesium Sulfate for Post-Operative Pain Relief after Laparoscopic Cholecystectomy, A Randomized Double-Blind Comparison Study

“…It is legitimately inexpensive, technically uncomplicated, and may probably diminish postoperative embarrassment [24]. Perioperative localization anesthesia (LIA) is one of the ultimate techniques for accomplish these scopes [25][26][27]. LIA to the surgery site is a simple way and has demonstrated an immense impact on the abdomen, chest and plastic surgical setting.…”