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Postoperative pain relief after total hip arthroplasty: a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia
Univ Hosp, Dept Anaesthesiol & Intens Care, Orebro, Sweden.;Univ Hosp, Inst Med & Hlth, Orebro, Sweden..
Univ Hosp, Dept Orthopaed Surg, Orebro, Sweden.;Univ Hosp, Inst Med & Hlth, Orebro, Sweden..
Univ Hosp, Dept Anaesthesiol & Intens Care, Orebro, Sweden..
Univ Hosp, Clin Epidemiol & Biostat Unit, Orebro, Sweden..
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2013 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 111, no 5, 793-799 p.Article in journal (Refereed) Published
Abstract [en]

Postoperative pain after total hip arthroplasty (THA) can delay mobilization. This was assessed after intrathecal morphine (ITM) compared with local infiltration analgesia (LIA) using a non-inferiority design. Eighty patients were recruited in this randomized, double-blind study. ITM 0.1 mg (Group ITM) or periarticular local anaesthetic (ropivacaine 300 mg)ketorolac 30 mg epinephrine 0.5 mg (total volume 151.5 ml) (Group LIA) were compared. After 24 h, 22 ml of saline (Group ITM) or ropivacaine (150 mg)ketorolac (30 mg)epinephrine (0.1 mg) (Group LIA) were injected via a catheter. After operation, rescue analgesic consumption, pain intensity, and home-readiness were measured. Morphine consumption was equivalent, median difference 0 mg (95 confidence interval 4 to 4.5) between the groups at 024 h. During 2448 h, it was lower in Group LIA (3 mg, 060 mg, median, range) compared with Group ITM (10 mg, 081 mg) (P0.01). Lower pain scores were recorded at rest at 8 h in Group ITM (P0.01), but in Group LIA on standing and mobilization, at 2448 h (P0.01). Paracetamol and tramadol consumption was lower in Group LIA (P0.05 and 0.05, respectively) as was pruritus, nausea, and vomiting (P0.05). Lower pain intensity was recorded early after surgery in ITM group but later, analgesic consumption, pain intensity on mobilization, and side-effects were lower in patients receiving LIA. LIA is a good alternative to ITM in patients undergoing THA.

Place, publisher, year, edition, pages
2013. Vol. 111, no 5, 793-799 p.
Keyword [en]
analgesic techniques, infiltration, pain, postoperative, surgery, orthopaedic
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:oru:diva-56584DOI: 10.1093/bja/aet248ISI: 000325759100015PubMedID: 23872462OAI: oai:DiVA.org:oru-56584DiVA: diva2:1083038
Available from: 2017-03-20 Created: 2017-03-20 Last updated: 2017-03-20Bibliographically approved

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