No evidence of a clinically important effect of adding local infusion analgesia administrated through a catheter in pain treatment after total hip arthroplasty.

Abstract

BACKGROUND AND PURPOSE:

Postoperative analgesia after primary total hip arthroplasty (THA) using opioids is associated with troublesome side effects such as nausea and dizziness, and epidural analgesic means delayed mobilization. Thus, local infiltration analgesia (LIA) during surgery prolonged with local infusion analgesia (LINFA) into the soft tissue in the hip region through a catheter in the first postoperative days has gained major interest in THA fast-track settings within a short period of time. LIA at the time of surgery is a validated treatment. We investigated the additional effect of giving postoperative LINFA after THA in patients already having LIA during surgery.

PATIENTS AND METHODS:

60 consecutive patients undergoing non-cemented THA were randomized into two groups in a double-blind and controlled study. During surgery, all patients received standardized pain treatment with LIA. Postoperatively, they were treated either with a solution of Ropivacain, Ketorolac, and Adrenaline (LINFA group) or placebo (placebo group) administered through a catheter to the hip 10 and 22 h after surgery. Pain score, opioid consumption, and length of stay (LOS) were evaluated.

RESULTS:

After adjustment for multiple testing, there was no statistically significant postoperative difference between the LINFA group and the placebo group regarding pain and tiredness. We found some evidence of a short-term effect on nausea and vomiting. Opioid consumption and length of stay were similar in the two groups.

INTERPRETATION:

We found some evidence of a short-term effect of LINFA on nausea and vomiting, but no evidence of an effect on postoperative pain and tiredness. Thus, LINFA cannot be recommended as a standard pain treatment in patients with THA.

• Authors: Kirsten Specht, Jane Schwartz Leonhardt, Peter Revald, Hans Mandøe, Else Bay Andresen, John Brodersen, Svend Kreiner, Per Kjaersgaard-Andersen
• Journal: Acta orthopaedica (Acta Orthop) Vol. 82 Issue 3 Pg. 315-20 (Jun 2011) ISSN: 1745-3682 [Electronic] Sweden
• PMID: 21619503 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Amides
• Analgesics
• Analgesics, Opioid
• Anesthetics, Local
• Ropivacaine
• Epinephrine
• Ketorolac

Topics

• Aged
• Aged, 80 and over
• Amides (administration & dosage)
• Analgesics (administration & dosage)
• Analgesics, Opioid (administration & dosage)
• Anesthetics, Local (administration & dosage)
• Arthroplasty, Replacement, Hip (adverse effects)
• Catheters
• Double-Blind Method
• Epinephrine (administration & dosage)
• Female
• Humans
• Ketorolac (administration & dosage)
• Length of Stay
• Male
• Middle Aged
• Pain Measurement
• Pain, Postoperative (drug therapy)
• Ropivacaine
• Self Report
• Treatment Outcome