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

Janne Kristin Hofstad, Siri B Winther, Torbjørn Rian, Olav A Foss, Otto S Husby, Tina S Wik, Janne Kristin Hofstad, Siri B Winther, Torbjørn Rian, Olav A Foss, Otto S Husby, Tina S Wik

Abstract

Background and purpose: The local infiltration analgesia (LIA) technique has been widely used to reduce opioid requirements and to improve postoperative mobilization following total hip arthroplasty (THA). However, the evidence for the efficacy of LIA in THA is not yet clear. We determined whether single-shot LIA in addition to a multimodal analgesic regimen would reduce acute postoperative pain and opioid requirements after THA.

Patients and methods: 116 patients undergoing primary THA under spinal anesthesia were included in this randomized, double-blind, placebo-controlled trial. All patients received oral opioid-sparing multimodal analgesia: etoricoxib, acetaminophen, and glucocorticoid. The patients were randomized to receive either 150 mL ropivacaine (2 mg/mL) and 0.5 mL epinephrine (1 mg/mL) or 150 mL 0.9% saline. Rescue analgesic consisted of morphine and oxycodone as needed. The primary endpoint was pain during mobilization in the recovery unit. Secondary endpoints were pain during mobilization on the day after surgery and total postoperative opioid requirements on the first postoperative day.

Results: The levels of pain during mobilization-both in the recovery unit and on the day after surgery-and consumption of opioids on the first postoperative day were similar in the 2 groups.

Interpretation: LIA did not provide any extra analgesic effect after THA over and above that from the multimodal analgesic regimen used in this study.

Figures

Figure 1.
Figure 1.
CONSORT 2011 flow chart of patients throughout the study.
Figure 2.
Figure 2.
Box plot showing pain score (NRS) during mobilization in the post-anesthesia care unit (PACU) and on the first postoperative day. The horizontal lines indicate median. The boxes represent interquartile range and the whiskers extend to the minimum or maximum case/value within 1.5 times the height of the boxes.

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