Postoperative pain relief after total hip arthroplasty: a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia

Kuchalik, Jan; Granath, B.; Ljunggren, Anne Elisabeth; Magnuson, Anders; Lundin, Anders; Gupta, Anil

doi:10.1093/bja/aet248

Cited by 72 publications

(57 citation statements)

References 25 publications

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“…3). In addition to the RCTs included in the two pairwise meta-analyses, Bayesian network meta-analysis included 10 more RCTs [3,12,14,19,32,45,48,53,55,61] comparing use of local infiltration analgesia or peripheral nerve blocks with epidural analgesia or intrathecal morphine. By introducing the additional indirect comparisons (epidural analgesia, intrathecal morphine) we increased the power and precision of the network meta-analysis (Appendix 1.…”

Section: Discussionmentioning

confidence: 99%

Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis

Jiménez-Almonte

Wyles

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Local infiltration analgesia and peripheral nerve blocks are common methods for pain management in patients after THA but direct head-to-head, randomized controlled trials (RCTs) have not been performed. A network meta-analysis allows indirect comparison of individual treatments relative to a common comparator; in this case placebo (or no intervention), epidural analgesia, and intrathecal morphine, yielding an estimate of comparative efficacy. Questions/purposes We asked, when compared with a placebo, (1) does use of local infiltration analgesia reduce patient pain scores and opioid consumption, (2) does use of peripheral nerve blocks reduce patient pain scores and opioid consumption, and (3) is local infiltration analgesia favored over peripheral nerve blocks for postoperative pain management after THA? Methods We searched six databases, from inception through June 30, 2014, to identify RCTs comparing local infiltration analgesia or peripheral nerve block use in patients after THA. A total of 35 RCTs at low risk of bias based on the recommended Cochrane Collaboration risk assessment tool were included in the network meta-analysis (2296 patients). Primary outcomes for this review were patient pain scores at rest and cumulative opioid consumption, both assessed at 24 hours after THA. Because of substantial heterogeneity (variation of outcomes between studies) across included trials, a random effect model for meta-analysis was used to estimate the weighted mean difference (WMD) and 95% CI. The gray literature was searched with the same inclusion criteria as published One of the authors certifies that he (RJS), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000, from Biomet Inc (Warsaw, IN, USA 123Clin Orthop Relat Res (2016) 474:495-516 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® trials. Only one unpublished trial (published abstract) fulfilled our criteria and was included in this review. All other studies included in this systematic review were full published articles. Bayesian network meta-analysis included all RCTs that compared local infiltration analgesia or peripheral nerve blocks with placebo (or no intervention), epidural analgesia, and intrathecal morphine. Results Compared with placebo, local infiltration analgesia reduced patient pain scores (WMD, À0.61; 95% CI, À0.97 to À0.24; p = 0.001) and opioid consumption (WMD, À7.16 mg; 95% CI, À11.98 to À2.35; p = 0.004). Peripheral nerve blocks did not result in lower pain scores or reduced opioid consumption compared with placebo (WMD, À0.43; 95% CI, À0.99 to 0.12; p = 0.12 and WMD, À3.14 mg, 95% CI, À11.30 to 5.02; p = 0.45). However, network meta-analysis comparing local infiltration analgesia with peripheral nerve blocks through common comparators showed no differences between postoperative pain scores (WMD, À0.36; 95% CI, À1.06 to 0.31) and opioid consumption (WMD, À4....

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Section: Discussionmentioning

confidence: 99%

Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis

Jiménez-Almonte

Wyles

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Addition of NSAIDs to the LIA mixture without giving NSAIDs to the control group makes the results of the studies difficult to interpret (Andersen et al 2007, Kerr and Kohan 2008, Kuchalik et al 2013, Solovyova et al 2013) as NSAIDs have both a systematic and a local anti-inflammatory effect (Romsing et al 2000). Instead of measuring the effect of the local infiltration analgesia, it may be the effect of NSAID(s) that is measured, which complicates the comparison between LIA and placebo.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, these are often used in combination with a LIA catheter placed intraoperatively giving repeated injections postoperatively (Andersen et al 2007, Kerr and Kohan 2008, Murphy et al 2012, Kuchalik et al 2013, Solovyova et al 2013, Zoric et al 2014). This further complicates interpretation and comparison of the results.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

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confidence: 99%

“…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.…”

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

et al. 2015

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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.

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Krieger¹,

Elias²,

Hartmann³

2020

Orthopäde

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Postoperative pain relief after total hip arthroplasty: a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia

Abstract: Lower pain intensity was recorded early after surgery in ITM group but later, analgesic consumption, pain intensity on mobilization, and side-effects were lower in patients receiving LIA. LIA is a good alternative to ITM in patients undergoing THA.

Cited by 72 publications

References 25 publications

Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis

Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis

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

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