High-volume infiltration analgesia in bilateral hip arthroplasty
Lasse Ø Andersen, 1,4 Kristian S Otte, 2,4 Henrik Husted, 2,4 Lissi Gaarn-Larsen, 1,4 Billy Kristensen, 1,4 and Henrik Kehlet 3,4Hip
Background and purpose
High-volume infiltration analgesia may be effective in postoperative pain management after hip arthroplasty but methodological problems prevent exact interpretation of previous studies.
Methods
In a randomized, double-blind placebo-controlled trial in 12 patients undergoing bilateral total hip arthroplasty (THA) in a fast-track setting, saline or high-volume (170 mL) ropivacaine (0.2%) with epinephrine (1:100,000) was administered to the wound intraoperatively along with supplementary postoperative injections via an intraarticular epidural catheter. Oral analgesia was instituted preoperatively with a multimodal regimen (gabapentin, celecoxib, and acetaminophen). Pain was assessed repeatedly for 48 hours postoperatively, at rest and with 45° hip flexion.
Results
Pain scores were low and similar between ropivacaine and saline administration. Median hospital stay was 4 (range 2–7) days.
Interpretation
Intraoperative high-volume infiltration with 0.2% ropivacaine with repeated intraarticular injections postoperatively may not give a clinically relevant analgesic effect in THA when combined with a multimodal oral analgesic regimen with gabapentin, celecoxib, and acetaminophen.
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