Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty: A randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients

Abstract

Background Epidural analgesia gives excellent pain relief but is associated with substantial side effects. We compared wound infiltration combined with intraarticular injection of local anesthetics for pain relief after total hip arthroplasty (THA) with the well-established practice of epidural infusion. Methods 80 patients undergoing elective THA under spinal block were randomly assigned to receive either (1) continuous epidural infusion (group E) or (2) infiltration around the hip joint with a mixture of 100 mL ropivacaine 2 mg/mL, 1 mL ketorolac 30 mg/mL, and 1 mL epinephrine 0.5 mg/mL at the conclusion of surgery combined with one postoperative intraarticular injection of the same substances through an intraarticular catheter (group A). Results Narcotic consumption was significantly reduced in group A compared to group E (p = 0.004). Pain levels at rest and during mobilization were similar in both groups but significantly reduced in group A after cessation of treatment. Length of stay was reduced by 2 days (36%) in group A compared to group E (p < 0.001).Interpretation Wound infiltration combined with 1 intraarticular injection can be recommended for patients undergoing THA. Further studies of dosage (high/low) and duration of intraarticular treatment are warranted.

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

“…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.…”

“…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.…”

“…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.…”

A compression bandage improves local infiltration analgesia in total knee arthroplasty

“…Various techniques of peripheral nerve blockade or continuous epidural analgesia can control postoperative pain, but they are associated with a number of side effects and require expertise and/or supervision (Choi et al 2003, Davies et al 2004, Boezaart 2006. Another approach is local infiltration analgesia (LIA), which has proven safe and efficient in reducing postoperative pain after TKA with no impairment of postoperative mobilization (Reilly et al 2005, Busch et al 2006, Vendittoli et al 2006, Andersen et al 2007a, b, Toftdahl et al 2007.…”

Analyzing the Efficacy of Pain Management and Continuous Infusion Regional Anesthetic Catheters in the Orthopaedic Setting

“…Ropivacaine is preferred as it has a slower onset and a decreased risk for central nervous system toxicity related to its lower lipid solubility and lower risk of crossing the blood brain barrier. 10 An in-depth analysis of relevant research along with my clinical experience reveals that the benefits of nerve block catheters include: better pain control and decreased narcotic use, 11 reduced side effects related to decreased narcotic use, 12 earlier ambulation after surgery helping prevent skin breakdown and thrombosis development, 11 and the fact that it is a more economical means of pain management than simply Health and Natural Sciences WURJ narcotics alone. 13 However, the drawbacks include: reports that these catheters do not block all pain (especially posterior to the kneecap) thus requiring opioid use in conjunction, 13 an increased risk for falls related to the location of the catheter, 14 an increased risk for infection related to dislodgement of the catheter as well as nerve injury related to placement by the anesthesiologist, 12 and the risk of anesthetic toxicity related to the patient's tolerance and the dose of medication.…”