High-volume infiltration analgesia in bilateral hip arthroplasty. A randomized, double-blind placebo-controlled trial

Abstract

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.

Postoperative pain after bilateral hip arthroplasty (n = 12) with local infiltration of ropivacaine or saline intraoperatively. Re-injection of ropivacaine or saline after 8 h (20 mL/40 mg) and 24 h (50 mL/100 mg). Values are median with twenty-fifth and seventy-fifth percentiles. VAS: visual analog scale, where 0 cm = no pain and 10 cm = worst pain. * p < 0.05. The arrows indicate re-injection times.