Local Anesthetic Wound Infiltration after Osteosynthesis of Extracapsular Hip Fracture Does Not Reduce Pain or Opioid Requirements: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial in 49 Patients

Rune D Bech, Ole Ovesen, Jens Lauritsen, Claus Emmeluth, Peter Lindholm, Søren Overgaard, Rune D Bech, Ole Ovesen, Jens Lauritsen, Claus Emmeluth, Peter Lindholm, Søren Overgaard

Abstract

Background and purpose: Local infiltration analgesia (LIA) supports early mobilization after hip and knee arthroplasty. Inspired by this, we studied the effectiveness of wound infiltration with the long acting local anesthetic ropivacaine in an effort to decrease the need for postoperative opioids after osteosynthesis of extracapsular hip fracture.

Methods: Forty-nine patients undergoing osteosynthesis with a sliding hip screw were randomized into two groups in a double-blind study (ClinicalTrials.gov:NCT01119209). The patients received intraoperative infiltration followed by 6 postoperative injections through a wound catheter in eight-hour intervals. 23 patients received ropivacaine and 26 received saline. The intervention period was 2 days, and the observation period was 5 days. In both groups, there were no restrictions on the total daily dose of opioids. Pain was assessed at specific postoperative time points, and the daily opioid usage was registered.

Results: Intraoperative infiltration with 200 mg ropivacaine and postoperative repeated infiltration with 100 mg ropivacaine did not result in statistically significant difference between the groups regarding postoperative opioid consumption or pain.

Interpretation: Ropivacaine as single component in postoperative treatment of pain after hip fracture is not effective. In our setup, wound infiltration with ropivacaine is not statistically significantly better than placebo.

Figures

Figure 1
Figure 1
Flowchart of eligible patients. aFive patients were transferred to other hospitals for osteosynthesis before randomization. bFour patients did not receive the allocated intervention. Four patients expected to undergo osteosynthesis with a sliding hip screw were converted to intramedullary nailing. One patient received a femoralis nerve block. One patient was excluded because of significant knee pain caused by the trauma. One patient did not understand the concept of patient-controlled analgesia. Two patients were transferred to surgery in other hospitals. cFour patients did not receive the allocated intervention. One patient received regularly administered opioids and not on demand. One patient accidently removed his catheter. One patient developed delirium before surgery. One patient had insufficient reposition of the fracture and had a re-operation. One patient was transferred to surgery in another hospital. Three patients expected to undergo osteosynthesis with a sliding hip screw were converted to intramedullary nailing.
Figure 2
Figure 2
Consumption of oxycodone, all patients: (POD 1: p=0.9), (POD 2: p=0.5), (POD 3: p=0.4), (POD 4: p=0.3), and (POD 5: p=0.7). Postoperative day (POD).
Figure 3
Figure 3
Consumption of oxycodone in the spinal anesthesia group: (POD 1: p=0.1), (POD 2: p=0.4), (POD 3: p=0.8), (POD 4: p=0.6), and (POD 5: p=0.5). Postoperative day (POD).

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