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Local infiltration analgesia: a 2-year follow-up of patients undergoing total hip arthroplasty
Örebro University, School of Medical Sciences. Department of Anaesthesiology and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
Department of Orthopaedic Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; Department of Anaesthesiology and Intensive Care, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0001-6128-7752
2017 (English)In: Journal of Anesthesia, ISSN 0913-8668, E-ISSN 1438-8359, Vol. 31, no 6, p. 837-845Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Local infiltration analgesia (LIA) is commonly used for postoperative pain management following total hip arthroplasty (THA). However, the long-term effects of the component drugs are unclear. The aim of our study was to investigate functional outcome, quality of life, chronic post-surgical pain, and adverse events in patients within 2 years of undergoing THA.

METHODS: The study was a secondary analysis of data from a previous larger study. Eighty patients were randomized to receive either intrathecal morphine (Group ITM) or local infiltration analgesia (Group LIA) for pain management in a double-blind study. The parameters measured were patient-assessed functional outcome [using the Hip dysfunction and Osteo-arthritis Outcome Score (HOOS) questionnaire], health-related quality of life [using the European Quality of Life-5 dimensions (EQ-5D) questionnaire and the 36-Item Short Form Health Survey (SF-36) score], and pain using the numeric rating score (NRS), with persistent post-surgical pain having a NRS of > 3 or a HOOS pain sub-score of > 30. All complications and adverse events were investigated during the first 2 years after primary surgery.

RESULTS: Pain intensity and rescue analgesic consumption were similar between the groups after hospital discharge. No differences were found in HOOS or SF-36 score between the groups up to 6 months after surgery. A significant group × time interaction was seen in the EQ 5D form in favor of the LIA group. No between-group difference in persistent post-surgical pain was found at 3 or 6 months, or in adverse events up to 2 years after surgery.

CONCLUSION: Analysis of functional outcome, quality of life, and post-discharge surgical pain did not reveal significant differences between patients receiving LIA and those receiving ITM. LIA was found to be a safe technique for THA during the long-term follow-up. However, it should be noted that these conclusions are based on a limited number of patients.

Place, publisher, year, edition, pages
Springer Japan KK , 2017. Vol. 31, no 6, p. 837-845
Keywords [en]
Local anesthetics; Quality of life; Total hip arthroplasty; Postoperative complications
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:oru:diva-61185DOI: 10.1007/s00540-017-2403-6ISI: 000415131600006PubMedID: 28856511Scopus ID: 2-s2.0-85028593809OAI: oai:DiVA.org:oru-61185DiVA, id: diva2:1145829
Available from: 2017-09-29 Created: 2017-09-29 Last updated: 2018-08-06Bibliographically 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. p. 92
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 166
Keywords
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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