The efficacy of periarticular multimodal drug infiltration in total hip arthroplasty

Abstract

Background: Patient-controlled analgesia is a widely used and effective method of controlling pain after THA. This method is associated with substantial undesirable side effects. Local infiltration has been introduced in an attempt to reduce opioid requirements postoperatively, but its ability to reduce pain without complications is still questioned.

Questions/purposes: We evaluated patient-controlled analgesia use, pain and satisfaction scores, complication rates, and ropivacaine levels associated with the use of periarticular multimodal drug infiltration in THA.

Patients and methods: We randomized 64 patients undergoing THA to receive a periarticular intraoperative multimodal drug injection or to receive no injection. All patients received patient-controlled analgesia for 24 hours after surgery. The final assessment was at 6 weeks.

Results: Patients receiving the periarticular injection used less patient-controlled analgesia 6 hours postoperatively. The 24-hour patient-controlled analgesia requirement postsurgery also was less. The visual analog scale score for pain on activity in the postanesthetic care unit was less for patients who received an injection. The visual analog scale satisfaction score was similar in the two groups throughout the followup period. Recorded unbound ropivacaine levels were 2.5 times lower than toxic levels.

Conclusions: Periarticular intraoperative injection with multimodal drugs can reduce postoperative patient-controlled analgesia requirements and pain on activity in patients undergoing THA with no apparent increase in risk.

Level of evidence: Level I, therapeutic study. See the guidelines online for a complete description of level of evidence.

Figures

Fig. 1

A CONSORT flowchart describes patient selection.

Fig. 2

A graph showing 24-hour PCA morphine consumption in patients after THA. Patients undergoing THA receiving the multimodal drug infiltration used less (p = 0.0023) PCA at 6 hours postoperation and less (p = 0.0093) overall PCA during the first 24 hours after surgery. Data are presented as means (bars) with SD (error bars).

Fig. 3

VAS scores for pain in patients after THA are shown. The VAS score for pain on activity was lower (p = 0.0019) in the injected group in the PACU. PACU = postanesthetic care unit; 4 h Post = 4 hours postoperative; POD1 = Postoperative Day 1; POD3 = Postoperative Day 3; POD5 = Postoperative Day 5; D/C = discharge; 6wk F/U = 6 weeks’ followup. Data are presented as means (bars) with SD (error bars).

Fig. 4

VAS scores for satisfaction in patients after THA are shown. The VAS scores for patient satisfaction were similar between the groups. PACU = postanesthetic care unit; 4 h Post = 4 hours postoperative; POD1 = Postoperative Day 1; POD3 = Postoperative Day 3; POD5 = Postoperative Day 5; D/C = discharge; 6wk F/U = 6 weeks’ followup. Data are presented as means (bars) with SD (error bars).