Comparison of the Effect of Different Local Analgesia Administration Techniques in Total Hip Arthroplasty: A Retrospective Comparative Cohort Study

Akira Hashimoto, Motoki Sonohata, Atsushi Kawaguchi, Sakumo Kii, Hirohito Hirata, Masaaki Mawatari, Akira Hashimoto, Motoki Sonohata, Atsushi Kawaguchi, Sakumo Kii, Hirohito Hirata, Masaaki Mawatari

Abstract

Objective: To improve postoperative pain management, several authors have described the use of periarticular injection (PAI) or intra-articular injection (IAI) following total hip arthroplasty (THA). However, no comparative studies examining the results between PAI and IAI following THA have been published. This study aimed to evaluate the analgesic and anti-inflammatory effects of PAI and IAI following THA.

Methods: This single-center, retrospective cohort study enrolled patients who underwent unilateral primary THA. A total of 278 patients (281 hips) were included in the final analyses, with 112 patients (113 hips) in the control group, 85 patients (87 hips) in the PAI group, and 81 patients (81 hips) in the IAI group. Numeric rating scale (NRS) scores and laboratory data were assessed preoperatively and on postoperative days (POD) 1 and 7.

Results: NRS scores, creatine phosphokinase, and C-reactive protein levels in the PAI and IAI groups were significantly lower than those in the control group on POD 1 and 7. D-dimer levels were significantly lower in the PAI and IAI groups than in the control group on POD 7. The white blood cell count was significantly higher in the PAI and IAI groups than in the control group on POD 1 and 7. Aspartate transaminase, alanine aminotransferase, blood urea nitrogen, and creatinine levels were within the reference ranges in all three groups at all time points. NRS scores and laboratory data showed no significant differences between the PAI and IAI groups at all time points.

Conclusion: PAI and IAI have equivalent analgesic and anti-inflammatory effects. Considering the technical challenges of PAI, IAI may be preferable because of its simplicity in the case of using a closed suction drain.

Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Copyright © 2021 Akira Hashimoto et al.

Figures

Figure 1
Figure 1
Comparison of NRS scores among the three groups (a) and within each group (b). Significant differences between the control and PAI groups are marked as ∗p < 0.05. Significant differences between the control and IAI groups are marked as †p < 0.05. Significant differences between the PAI and IAI groups are marked as §p < 0.05. Significant differences in perioperative data within the control group are marked as ¶p < 0.05. Significant differences in perioperative data within the PAI group are marked as ‡p < 0.05. Significant differences in perioperative data within the IAI group are marked as ||p < 0.05. PAI, periarticular injection; IAI, intra-articular injection; NRS, numeric rating scale.
Figure 2
Figure 2
Comparison of laboratory data among the three groups (a–h). The gray area represents the reference range for each laboratory value. Significant differences between the control and PAI groups are marked as ∗p < 0.05. Significant differences between the control and IAI groups are marked as †p < 0.05. Significant differences between the PAI and IAI groups are marked as §p < 0.05. PAI, periarticular injection; IAI, intra-articular injection; WBC, white blood cell count; AST, aspartate transaminase; ALT, alanine aminotransferase; CK, creatine phosphokinase; BUN, blood urea nitrogen; Cr, creatinine; CRP, C-reactive protein.
Figure 3
Figure 3
Comparison of laboratory data within each group (a–h). The gray area represents the reference range for each laboratory value. Significant differences in perioperative data within the control group are marked as ¶p < 0.05. Significant differences in perioperative data within the PAI group are marked as ‡p < 0.05. Significant differences in perioperative data within the IAI group are marked as ||p < 0.05. PAI, periarticular injection; IAI, intra-articular injection; WBC, white blood cell count; AST, aspartate transaminase; ALT, alanine aminotransferase; CK, creatine phosphokinase; BUN, blood urea nitrogen; Cr, creatinine; CRP, C-reactive protein.

References

    1. Hamilton D. F., Lane J. V., Gaston P., et al. What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement. BMJ Open. 2013;3(4) doi: 10.1136/bmjopen-2012-002525.e002525
    1. Parvataneni H. K., Shah V. P., Howard H., Cole N., Ranawat A. S., Ranawat C. S. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. The Journal of Arthroplasty. 2007;22(6 Suppl 2):33–38. doi: 10.1016/j.arth.2007.03.034.
    1. Ohnuma T., Raghunathan K., Ellis A. R., et al. Effects of acetaminophen, NSAIDs, gabapentinoids, and their combinations on postoperative pulmonary complications after total hip or knee arthroplasty. Pain Medicine. 2020;21(10):2385–2393. doi: 10.1093/pm/pnaa017.
    1. Xu X., Wen H., Hu Y., Liu Z., Pan X. Efficacy of intra-articular magnesium for postoperative analgesia in total hip arthroplasty. Biomedical Reports. 2017;6(2):232–236. doi: 10.3892/br.2017.837.
    1. Cheng K.-Y., Feng B., Peng H.-M., et al. The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial. BMC Anesthesiology. 2020;20(1):p. 2. doi: 10.1186/s12871-019-0922-4.
    1. Hashimoto A., Sonohata M., Hirata H., et al. Periarticular analgesic injection containing a corticosteroid after total hip arthroplasty may prevent deep venous thrombosis: a retrospective comparative cohort study. BMC Musculoskeletal Disorders. 2021;22(1):p. 19. doi: 10.1186/s12891-020-03879-x.
    1. Aguirre J., Baulig B., Dora C., et al. Continuous epicapsular ropivacaine 0.3% infusion after minimally invasive hip arthroplasty: a prospective, randomized, double-blinded, placebo-controlled study comparing continuous wound infusion with morphine patient-controlled analgesia. Anesthesia and Analgesia. 2012;114(2):456–461. doi: 10.1213/ANE.0b013e318239dc64.
    1. Crowe J. F., Mani V. J., Ranawat C. S. Total hip replacement in congenital dislocation and dysplasia of the hip. The Journal of Bone & Joint Surgery. 1979;61(1):15–23. doi: 10.2106/00004623-197961010-00004.
    1. Rodriguez C. S. Pain measurement in the elderly: a review. Pain Management Nursing. 2001;2(2):38–46. doi: 10.1053/jpmn.2001.23746.
    1. Bahreini M., Safaie A., Mirfazaelian H., Jalili M. How much change in pain score does really matter to patients? The American Journal of Emergency Medicine. 2020;38(8):1641–1646. doi: 10.1016/j.ajem.2019.158489.
    1. Burlacu C. L., Buggy D. J. Update on local anesthetics: focus on levobupivacaine. Therapeutics and Clinical Risk Management. 2008;Volume 4(2):381–392. doi: 10.2147/tcrm.s1433.
    1. Dobie I., Bennett D., Spence D. J., Murray J. M., Beverland D. E. Periarticular local anesthesia does not improve pain or mobility after THA. Clinical Orthopaedics & Related Research. 2012;470(7):1958–1965. doi: 10.1007/s11999-012-2241-7.
    1. Murphy T. P., Byrne D. P., Curtin P., Baker J. F., Mulhall K. J. Can a periarticular levobupivacaine injection reduce postoperative opiate consumption during primary hip arthroplasty? Clinical Orthopaedics & Related Research. 2012;470(4):1151–1157. doi: 10.1007/s11999-011-2108-3.
    1. Jermak C. M., Dellacroce J. T., Heffez J., Peyman G. A. Triamcinolone acetonide in ocular therapeutics. Survey of Ophthalmology. 2007;52(5):503–522. doi: 10.1016/j.survophthal.2007.06.004.
    1. Salerno A., Hermann R. Efficacy and safety of steroid use for postoperative pain relief. The Journal of Bone and Joint Surgery-American Volume. 2006;88(6):1361–1372. doi: 10.2106/00004623-200606000-00029.
    1. Coll S., Monfort N., Alechaga É., Matabosch X., Pérez-Mañá C., Ventura R. Additional studies on triamcinolone acetonide use and misuse in sports: elimination profile after intranasal and high-dose intramuscular administrations. Steroids. 2019;151:p. 108464. doi: 10.1016/j.steroids.2019.108464.
    1. Goldstein R. A., Bowen D. L., Fauci A. S. Inflammation: Basic Principles and Clinical Correlates. New York, NY, USA: Raven Press; 1992. pp. 1061–1081.
    1. Ikeuchi M., Kamimoto Y., Izumi M., et al. Effects of dexamethasone on local infiltration analgesia in total knee arthroplasty: a randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy. 2014;22(7):1638–1643. doi: 10.1007/s00167-013-2367-5.
    1. Leverenz D., Zaha O., Crofford L. J., Chung C. P. Causes of creatine kinase levels greater than 1000 IU/L in patients referred to rheumatology. Clinical Rheumatology. 2016;35(6):1541–1547. doi: 10.1007/s10067-016-3242-9.
    1. Iaccarino L., Pegoraro E., Bello L., et al. Assessment of patients with idiopathic inflammatory myopathies and isolated creatin-kinase elevation. Autoimmunity Highlights. 2014;5(3):87–94. doi: 10.1007/s13317-014-0063-1.
    1. Brancaccio P., Maffulli N., Limongelli F. M. Creatine kinase monitoring in sport medicine. British Medical Bulletin. 2007;81-82(1):209–230. doi: 10.1093/bmb/ldm014.
    1. Clarkson P. M., Nosaka K., Braun B. Muscle function after exercise-induced muscle damage and rapid adaptation. Medicine & Science in Sports & Exercise. 1992;24(5):512–520. doi: 10.1249/00005768-199205000-00004.
    1. Gupta A., Kaur K., Sharma S., Goyal S., Arora S., Murthy R. S. Clinical aspects of acute post-operative pain management & its assessment. Journal of Advanced Pharmaceutical Technology & Research. 2010;1(2):97–108.
    1. Hall G. M., Peerbhoy D., Shenkin A., Parker C. J. R., Salmon P. Relationship of the functional recovery after hip arthroplasty to the neuroendocrine and inflammatory responses †. British Journal of Anaesthesia. 2001;87(4):537–542. doi: 10.1093/bja/87.4.537.
    1. Nakai T., Nakamura T., Nakai T., Onishi A., Hashimoto K. A study of the usefulness of a periarticular multimodal drug cocktail injection for pain management after total hip arthroplasty. Journal of Orthopaedics. 2013;10(1):5–7. doi: 10.1016/j.jor.2013.01.011.
    1. Wells P. S., Anderson D. R., Rodger M., et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. New England Journal of Medicine. 2003;349(13):1227–1235. doi: 10.1056/nejmoa023153.
    1. Pearse E. O., Caldwell B. F., Lockwood R. J., Hollard J. Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. The Journal of Bone and Joint Surgery. British Volume. 2007;89-B(3):316–322. doi: 10.1302/0301-620x.89b3.18196.
    1. Fauci A. S., Dale D. C., Balow J. E. Glucocorticosteroid therapy: mechanisms of action and clinical considerations. Annals of Internal Medicine. 1976;84(3):304–315. doi: 10.7326/0003-4819-84-3-304.
    1. Cox G. Glucocorticoid treatment inhibits apoptosis in human neutrophils. Separation of survival and activation outcomes. Journal of Immunology (Baltimore, Md.: 1950) 1995;154(9):4719–4725.
    1. Meagher L. C., Cousin J. M., Seckl J. R., Haslett C. Opposing effects of glucocorticoids on the rate of apoptosis in neutrophilic and eosinophilic granulocytes. Journal of Immunology (Baltimore, Md.: 1950) 1996;156(11):4422–4428.
    1. Liu Q., Wang Y., Chen Z., Guo X., Lv Y. Age- and sex-specific reference intervals for blood urea nitrogen in Chinese general population. Scientific Reports. 2021;11(1):p. 10058. doi: 10.1038/s41598-021-89565-x.
    1. Hasselgren P.-O. Glucocorticoids and muscle catabolism. Current Opinion in Clinical Nutrition and Metabolic Care. 1999;2(3):201–205. doi: 10.1097/00075197-199905000-00002.
    1. Pratt D. S., Kaplan M. M. Evaluation of abnormal liver-enzyme results in asymptomatic patients. New England Journal of Medicine. 2000;342(17):1266–1271. doi: 10.1056/nejm200004273421707.
    1. Bajwa S. J., Kaur J. Clinical profile of levobupivacaine in regional anesthesia: a systematic review. Journal of Anaesthesiology Clinical Pharmacology. 2013;29(4):530–539. doi: 10.4103/0970-9185.119172.
    1. Moore C. D., Roberts J. K., Orton C. R., et al. Metabolic pathways of inhaled glucocorticoids by the CYP3A enzymes. Drug Metabolism and Disposition. 2013;41(2):379–389. doi: 10.1124/dmd.112.046318.
    1. Gowda S., Desai P. B., Kulkarni S. S., Hull V. V., Math A. A., Vernekar S. N. Markers of renal function tests. North American Journal of Medical Sciences. 2010;2(4):170–173.
    1. Fede C., Porzionato A., Petrelli L., et al. Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain. Journal of Orthopaedic Research. 2020;38(7):1646–1654. doi: 10.1002/jor.24665.
    1. Ueno M., Sonohata M., Fukumori N., Kawano S., Kitajima M., Mawatari M. Comparison between topical and intravenous administration of tranexamic acid in primary total hip arthroplasty. Journal of Orthopaedic Science. 2016;21(1):44–47. doi: 10.1016/j.jos.2015.10.011.
    1. Mauerhan D. R., Campbell M., Miller J. S., Mokris J. G., Gregory A., Kiebzak G. M. Intra-articular morphine and/or bupivacaine in the management of pain after total knee arthroplasty. The Journal of Arthroplasty. 1997;12(5):546–552. doi: 10.1016/s0883-5403(97)90178-9.
    1. Waugh T. R., Stinchfield F. E. Suction drainage of orthopaedic wounds. The Journal of Bone & Joint Surgery. 1961;43(7):939–1021. doi: 10.2106/00004623-196143070-00002.
    1. Kelly E. G., Cashman J. P., Imran F. H., Conroy R., O,Byrne J. Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty. Surgical Technology International. 2014;24:295–301.
    1. Xu H., Xie J., Lei Y., Huang Q., Huang Z., Pei F. Closed suction drainage following routine primary total joint arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a retrospective cohort study. Journal of Orthopaedic Surgery and Research. 2019;14(1):p. 163. doi: 10.1186/s13018-019-1211-0.

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