Addition of corticosteroid to periarticular injections reduces postoperative pain following total hip arthroplasty under general anaesthesia: a double-blind randomized controlled trial

Kenji Kurosaka, Sachiyuki Tsukada, Hiroyuki Ogawa, Masahiro Nishino, Tsutomu Nakayama, Shinichi Yoshiya, Naoyuki Hirasawa, Kenji Kurosaka, Sachiyuki Tsukada, Hiroyuki Ogawa, Masahiro Nishino, Tsutomu Nakayama, Shinichi Yoshiya, Naoyuki Hirasawa

Abstract

Aims: Although periarticular injection plays an important role in multimodal pain management following total hip arthroplasty (THA), there is no consensus on the optimal composition of the injection. In particular, it is not clear whether the addition of a corticosteroid improves the pain relief achieved nor whether it is associated with more complications than are observed without corticosteroid. The aim of this study was to quantify the safety and effectiveness of cortocosteroid use in periarticular injection during THA.

Methods: We conducted a prospective, two-arm, parallel-group, randomized controlled trial involving patients scheduled for unilateral THA. A total of 187 patients were randomly assigned to receive periarticular injection containing either a corticosteroid (CS group) or without corticosteroid (no-CS group). Other perioperative interventions were identical for all patients. The primary outcome was postoperative pain at rest during the initial 24 hours after surgery. Pain score was recorded every three hours until 24 hours using a 100 mm visual analogue scale (VAS). The primary outcome was assessed based on the area under the curve (AUC).

Results: The CS group had a significantly lower AUC postoperatively at 0 to 24 hours compared to the no-CS group (AUC of VAS score at rest 550 ± 362 vs 392 ± 320, respectively; mean difference 158 mm; 95% confidence interval (CI) 58 to 257; p = 0.0021). In point-by-point evaluation, the CS group had significantly lower VAS scores at 12, 15, 18, 21, 24, and 48 hours. There were no significant differences in complication rates, including surgical site infection, between the two groups.

Conclusion: The addition of corticosteroid to periarticular injections reduces postoperative pain without increasing complication rate following THA. Cite this article: Bone Joint J 2020;102-B(10):1297-1302.

Keywords: Hip; Local infultration analgesia; Pain management; Periarticular injection; Total hip arthroplasty; corticosteroid.

Figures

Fig. 1
Fig. 1
Flow diagram of patients.
Fig. 2
Fig. 2
The pain scores at rest (mean and standard deviation) following total hip arthroplasty as rated on a 100 mm horizontal visual analoge scale (VAS). The corticosteroid group showed significantly lower VAS scores 12, 15, 18, 21, 24, and 48 hours after surgery (p = 0.003, p = 0.0003, p = 0.00002, p = 0.00001, p = 0.004, and p = 0.0007 respectively).

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