BACKGROUND:Epidural analgesia gives excellent pain relief but is associated with substantial side effects. We compared wound infiltration combined with intraarticular injection of local anesthetics for pain relief after total hip arthroplasty (THA) with the well-established practice of epidural infusion. METHODS:80 patients undergoing elective THA under spinal block were randomly assigned to receive either (1) continuous epidural infusion (group E) or (2) infiltration around the hip joint with a mixture of 100 mL ropivacaine 2 mg/mL, 1 mL ketorolac 30 mg/mL, and 1 mL epinephrine 0.5 mg/mL at the conclusion of surgery combined with one postoperative intraarticular injection of the same substances through an intraarticular catheter (group A). RESULTS:Narcotic consumption was significantly reduced in group A compared to group E (p = 0.004). Pain levels at rest and during mobilization were similar in both groups but significantly reduced in group A after cessation of treatment. Length of stay was reduced by 2 days (36%) in group A compared to group E (p < 0.001). INTERPRETATION: Wound infiltration combined with 1 intraarticular injection can be recommended for patients undergoing THA. Further studies of dosage (high/low) and duration of intraarticular treatment are warranted.
RCT Entities:
BACKGROUND: Epidural analgesia gives excellent pain relief but is associated with substantial side effects. We compared wound infiltration combined with intraarticular injection of local anesthetics for pain relief after total hip arthroplasty (THA) with the well-established practice of epidural infusion. METHODS: 80 patients undergoing elective THA under spinal block were randomly assigned to receive either (1) continuous epidural infusion (group E) or (2) infiltration around the hip joint with a mixture of 100 mL ropivacaine 2 mg/mL, 1 mL ketorolac 30 mg/mL, and 1 mL epinephrine 0.5 mg/mL at the conclusion of surgery combined with one postoperative intraarticular injection of the same substances through an intraarticular catheter (group A). RESULTS: Narcotic consumption was significantly reduced in group A compared to group E (p = 0.004). Pain levels at rest and during mobilization were similar in both groups but significantly reduced in group A after cessation of treatment. Length of stay was reduced by 2 days (36%) in group A compared to group E (p < 0.001). INTERPRETATION: Wound infiltration combined with 1 intraarticular injection can be recommended for patients undergoing THA. Further studies of dosage (high/low) and duration of intraarticular treatment are warranted.
Authors: Kethy M Jules-Elysee; Amanda K Goon; Geoffrey H Westrich; Douglas E Padgett; David J Mayman; Amar S Ranawat; Chitranjan S Ranawat; Yi Lin; Richard L Kahn; Devan D Bhagat; Enrique A Goytizolo; Yan Ma; Shane C Reid; Jodie Curren; Jacques T YaDeau Journal: J Bone Joint Surg Am Date: 2015-05-20 Impact factor: 5.284
Authors: José H Jiménez-Almonte; Cody C Wyles; Saranya P Wyles; German A Norambuena-Morales; Pedro J Báez; Mohammad H Murad; Rafael J Sierra Journal: Clin Orthop Relat Res Date: 2015-11-16 Impact factor: 4.176