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Does local infiltration analgesia reduce peri-operative inflammation following total hip arthroplasty?: A randomized, double-blind study
Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care.
Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Research Laboratory, Örebro University Hospital, Örebro, Sweden.
Örebro University Hospital. Perioperative Medicine and Intensive Care, Institution for Physiology and Pharmacology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden; Karolinska University Hospital, Department of Anesthesiology and Intensive Care, Solna, Stockholm, Sweden.ORCID iD: 0000-0001-6128-7752
2017 (English)In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 17, 63Article in journal (Refereed) Published
Abstract [en]

Background: Postoperative inflammation following total hip arthroplasty (THA) can lead to delayed mobilization and return of hip function. Our primary aim was to assess whether local infiltration analgesia (LIA) during surgery can prevent postoperative inflammation.

Methods: This is a sub-analysis of data from a broader double-blind study where 56 patients received spinal anaesthesia for THA. Additionally, Group FNB (Femoral Nerve Block) received an ultrasound-guided femoral nerve block using 30 mL of ropivacaine 7.5 mg/mL (225 mg), and 151.5 mL of saline peri-articularly intra-operatively. Group LIA received 30 mL saline in the femoral nerve block and ropivacaine 2 mg/mL, 300 mg (150 mL) + ketorolac 30 mg (1 mL) + adrenaline 0.5 mg (0.5 mL) peri-articularly. After 23 h, the LIA mixture (22 mL) was injected via a catheter placed peri-articularly in Group LIA and 22 mL saline in Group FNB. A battery of pro-and anti-inflammatory cytokines was assessed using a commercially available kit preoperatively and after 4 h and 3 days postoperatively. Additionally, CRP, platelet count and white blood count was determined pre- and postoperatively.

Results: There was a general trend towards an increase in pro-inflammatory cytokines postoperatively, which returned to normal levels after 3 days. IL-6 concentration was significantly lower 4 h postoperatively in Group LIA compared to Group FNB (p = 0.015). No other significant differences were found between the groups in other cytokines. CRP levels were significantly higher in Group FNB compared to Group LIA 3 days postoperatively (p < 0.001). No other significant differences were seen between the groups.

Conclusion: Local infiltration analgesia has a modest but short-lasting effect on postoperative inflammation in patients undergoing total hip arthroplasty. This is likely to be due to local infiltration of ketorolac and/or local anaesthetics in the LIA mixture. Future studies should be directed towards assessing whether the use of LIA translates into better patient outcomes.

Place, publisher, year, edition, pages
BioMed Central, 2017. Vol. 17, 63
Keyword [en]
Total hip arthroplasty, Local infiltration analgesia, Postoperative inflammation
National Category
Anesthesiology and Intensive Care Surgery
Identifiers
URN: urn:nbn:se:oru:diva-57862DOI: 10.1186/s12871-017-0354-yISI: 000400426200001PubMedID: 28468607Scopus ID: 2-s2.0-85018738510OAI: oai:DiVA.org:oru-57862DiVA: diva2:1104077
Note

Funding Agency:

Research Committee, orebro University HospitaL  OLL-590351

Available from: 2017-05-31 Created: 2017-05-31 Last updated: 2017-10-18Bibliographically 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)
Opponent
Supervisors
Available from: 2017-06-16 Created: 2017-06-16 Last updated: 2017-09-29Bibliographically approved

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