The effect of a postoperative local anaesthetic pain pump in anterior total hip arthroplasty: a randomised control trial

Abstract

Introduction:

This project aims to determine if an addition of a local anaesthetic pain pump for 48 hours postoperatively effects verbal pain scores (VRS), opioid usage and length of stay (LOS) after anterior approach total hip arthroplasty (THA).

Methods:

This was a single-centre, single-surgeon, randomised, parallel-group study with balanced randomisation involving 108 patients. Randomisation and blinding were computer generated into 2 groups: local infiltration anaesthetic (LIA) only (Control Group) and LIA+ continuous postoperative infusion of local anaesthetic for 48 hours via a pain pump (Intervention Group). Postoperatively VRS (first 30 minutes, 1 hour, 2 hours and every 4 hours postoperatively up to 48 hours), opioid consumption, length of hospital admission, antiemetic and laxative usage were recorded. Statistical analysis utilised independent sample t-tests and repeated ANOVA.

Results:

Demographics and duration of surgery were similar across both cohorts. On average, compared to the control group, the intervention group required 2 mg less of opioid consumption over 48 hours (p = 0.41). VRS between the 2 groups showed no statistically significant difference. Scores ranged from 0 to 7, with an average of 1.28 in the intervention group and 1.29 in the control group (p = 0.31). 9 patients in the intervention group and 10 in the control group required antiemetics. There was no difference in the LOS or postoperative constipation. No complications or adverse events occurred.

Conclusions:

Our study has shown the addition of a continuous postoperative infusion of local anaesthetic for 48 hours post an anterior THA had no effect on VRS, opioid consumption, LOS and antiemetic usage.

Keywords

Anterior approach total hip arthroplasty arthroplasty local infiltration of anaesthetic postoperative outcomes

Get full access to this article

View all access options for this article.

References

Rawal

Hylander

Nydahl

, et al. Survey of postoperative analgesia following ambulatory surgery. Acta Anaesthesiol Scand 1997; 41: 1017–1022.

Goebel

Steinert

Schillinger

, et al Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop 2012; 36: 491–498.

Alecci

Valente

Crucil

, et al. Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol 2011; 12: 123–129.

Busch

Whitehouse

Shore

, et al. The efficacy of periarticular multimodal drug infiltration in total hip arthroplasty. Clin Orthop Relat Res 2010; 468: 2152–2159.

Bianconi

Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery. Br J Anaesth 2003; 91: 830–835.

Solovyova

Lewis

Abrams

, et al. Local infiltration analgesia followed by continuous infusion of local anesthetic solution for total hip arthroplasty: a prospective, randomized, double-blind, placebo-controlled study. J Bone Joint Surg Am 2013; 95: 1935–1941.

Andersen

Pfeiffer-Jensen

Haraldsted

, et al. Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty: a randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients. Acta Orthop 2007; 78: 180–186.

Bianconi

Ferraro

Traina

, et al. Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery. Br J Anaesth 2003; 91: 830–835.

Andersen

Otte

Husted

, et al. High-volume infiltration analgesia in bilateral hip arthroplasty. A randomized, double-blind placebo-controlled trial. Acta Orthop 2011; 82: 423–426.

10.

Kuchalik

Granath

Ljunggren

, et al. Postoperative pain relief after total hip arthroplasty: a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia. Br J Anaesth 2013; 111: 793–799.

11.

Murphy

Byrne

Curtin

, et al. Can a periarticular levobupivacaine injection reduce postoperative opiate consumption during primary hip arthroplasty? Clin Orthop Relat Res 2012; 470: 1151–1157.

12.

Kerr

Kohan

Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 2008; 79: 174–183.

13.

Dobie

Bennett

Spence

, et al. Periarticular local anesthesia does not improve pain or mobility after THA. Clin Orthop Relat Res 2012; 470: 1958–1965.

14.

Hofstad

Winther

Rian

, et al. Perioperative local infiltration anesthesia with ropivacaine has no effect on postoperative pain after total hip arthroplasty. Acta Orthop 2015; 86: 654–658.

15.

Den Hartog

Mathijssen

Van Dasselaar

, et al. No effect of the infiltration of local anaesthetic for total hip arthroplasty using an anterior approach: a randomised placebo controlled trial. Bone Joint J 2015; 97-B: 734–740.

16.

Specht

Leonhardt

Revald

, et al. No evidence of a clinically important effect of adding local infusion analgesia administrated through a catheter in pain treatment after total hip arthroplasty. Acta Orthop 2011; 82: 315–320.