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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: 2017-09-29Bibliographically approved
In thesis
1. Postoperative pain, inflammation and functional recovery after total hip arthroplasty: Prospective, randomized, clinical studies
Open this publication in new window or tab >>Postoperative pain, inflammation and functional recovery after total hip arthroplasty: Prospective, randomized, clinical studies
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Total hip arthroplasty (THA) is performed in patients with osteoarthritis of the hip joint. Pain following THA is often moderate but no gold stand-ard exists for pain management. Good postoperative pain management may lead to a better quality of life and hip function. In study I, we inves-tigated whether intrathecal morphine (ITM) or local infiltration analgesia (LIA) is better for pain management. Eighty patients were randomized to one of two groups, ITM or LIA in this randomized double-blind study. Lower pain intensity was recorded early after surgery (< 8 h) in ITM group but subsequently (> 24 h), analgesic consumption, pain intensity on mo-bilization, and side-effects were lower in patients receiving LIA. In study II, in a randomized, double blind study, we compared LIA with femoral nerve block (FNB) for pain management following THA in 56 patients. We found that LIA significantly reduces pain intensity on standing and mobilization at 24 -48 h, as well as rescue analgesic consumption (0 – 24 h) compared to FNB without causing significant side effects. In study III, the same patients were included as in study II to determine the role of inflammation on postoperative pain by analyzing a battery of cytokines in the plasma before and at fixed time points after surgery. We found that LIA has a modest but short-lasting effect (≈4 h) on postoperative inflam-mation, specifically IL-6. This is likely to be due to local infiltration of ketorolac and/or local anesthetics.

Study IV was a long-term follow-up of patients included in study I. We found no differences in quality of life or hip function up to 6 months after surgery when comparing LIA with ITM. Additionally, the incidence of persistent post-surgical pain and postoperative complications was similar between the groups and LIA had no long-term negative effects.

In conclusion, LIA is a good alternative to intrathecal morphine or fem-oral nerve block in patients undergoing THA. The analgesic effect may be due to anti-inflammatory effect of ketorolac injected locally or local anes-thetics. No negative long-term effects of LIA were found. The technique is efficacious, simple to apply and offers a good alternative to intrathecal morphine or femoral nerve block without negative effects during THA.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017. 92 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 166
Keyword
Total hip arthroplasty, local infiltration analgesia, intrathecal morphine, femoral nerve block, postoperative pain, spinal anesthesia
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-58066 (URN)978-91-7529-210-6 (ISBN)
Public defence
2017-10-27, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
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Available from: 2017-06-16 Created: 2017-06-16 Last updated: 2017-09-29Bibliographically approved

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