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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.
Örebro University, Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro, Sweden.
Örebro University, School of Medical Sciences. Orebro University Hospital. Clinical Research Laboratory.
Orebro 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
Identifiers
URN: urn:nbn:se:oru:diva-57862DOI: 10.1186/s12871-017-0354-yISI: 000400426200001PubMedID: 28468607ScopusID: 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: 2017-05-31Bibliographically approved

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CiteExportLink to record
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Citation style
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