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01-11-2016 | Original Paper

Effect of local anaesthetic wound infiltration on acute pain and bleeding after primary total hip arthroplasty: the EDIPO randomised controlled study

Authors: Guillaume Villatte, Emilien Engels, Roger Erivan, Aurélien Mulliez, Nicolas Caumon, Stéphane Boisgard, Stéphane Descamps

Published in: International Orthopaedics | Issue 11/2016

Abstract

Purpose

Total hip arthroplasty (THA) is considered a painful procedure with significant blood loss. The aim of the this study was to determine whether local infiltration analgaesia (LIA) (with long-acting local anaesthetics and epinephrine) during THA could reduce acute postoperative pain, improve early recovery and reduce per- and postoperative bleeding.

Methods

One hundred and fifty patients scheduled for primary THA were randomised into two groups. The treatment group received LIA (ropivacaine with epinephrine), whereas the control group had no infiltration. Pain intensity was measured with a visual analogue scale (VAS) for the duration of hospital stay and analgaesic consumption. Length of hospital stay, time to get out of bed alone and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index at 3, 6 and 12 months were recorded to evaluate recovery. Per- and postoperative bleeding were evaluated using direct and indirect criteria (operative blood loss, haemoglobin, estimation of uncompensated blood loss and red blood cell transfusion).

Results

Patients with LIA had significantly less pain during the first 24 h (p = 0.04). No significant differences were found in terms of analgaesic consumption (p = 0.57), early and delayed recovery or bleeding between groups.

Conclusions

Operative wound infiltration of LIA reduced acute pain after primary THA but did not improve recovery or influence per- and postoperative bleeding.

Singh JA (2011) Epidemiology of knee and hip arthroplasty: a systematic review. Open Orthop J 5:80–85. doi:10.2174/1874325001105010080 CrossRefPubMedPubMedCentral

Wylde V, Rooker J, Halliday L, Blom A (2011) Acute postoperative pain at rest after hip and knee arthroplasty: severity, sensory qualities and impact on sleep. Orthop Traumatol Surg Res OTSR 97:139–144. doi:10.1016/j.otsr.2010.12.003 CrossRefPubMed

Macrae WA (2008) Chronic postsurgical pain: 10 years on. Br J Anaesth 101:77–86. doi:10.1093/bja/aen099 CrossRefPubMed

Wylde V, Gooberman-Hill R, Horwood J et al (2011) The effect of local anaesthetic wound infiltration on chronic pain after lower limb joint replacement: a protocol for a double-blind randomised controlled trial. BMC Musculoskelet Disord 12:53. doi:10.1186/1471-2474-12-53 CrossRefPubMedPubMedCentral

Kerr DR, Kohan L (2008) Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 79:174–183. doi:10.1080/17453670710014950 CrossRefPubMed

Parvataneni HK, Shah VP, Howard H et al (2007) Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty 22:33–38. doi:10.1016/j.arth.2007.03.034 CrossRefPubMed

Aguirre J, Baulig B, Dora C et al (2012) Continuous epicapsular ropivacaine 0.3 % infusion after minimally invasive hip arthroplasty: a prospective, randomized, double-blinded, placebo-controlled study comparing continuous wound infusion with morphine patient-controlled analgesia. Anesth Analg 114:456–461. doi:10.1213/ANE.0b013e318239dc64 CrossRefPubMed

Kuchálik J, Granath B, Ljunggren A et al (2013) Postoperative pain relief after total hip arthroplasty: a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia. Br J Anaesth 111:793–799. doi:10.1093/bja/aet248 CrossRefPubMed

Whiting PS, Molina CS, Greenberg SE et al (2015) Regional anaesthesia for hip fracture surgery is associated with significantly more peri-operative complications compared with general anaesthesia. Int Orthop 39:1321–1327. doi:10.1007/s00264-015-2735-5 CrossRefPubMed

10.

Martin C (2011) Antibioprophylaxie en chirurgie et médecine interventionnelle. (Patients adultes) Actualisation 2010. In: Ann. Fr. Anesth. Réanimation. Elsevier, pp 168–190

11.

Mercuriali F, Inghilleri G (1996) Proposal of an algorithm to help the choice of the best transfusion strategy. Curr Med Res Opin 13:465–478. doi:10.1185/03007999609115227 CrossRefPubMed

12.

Andersen LØ, Kehlet H (2014) Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. Br J Anaesth 113:360–374. doi:10.1093/bja/aeu155 CrossRefPubMed

13.

Ibrahim MS, Twaij H, Giebaly DE et al (2013) Enhanced recovery in total hip replacement: a clinical review. Bone Jt J 95-B:1587–1594. doi:10.1302/0301-620X.95B12.31303 CrossRef

14.

Kehlet H, Andersen LØ (2011) Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice. Acta Anaesthesiol Scand 55:778–784. doi:10.1111/j.1399-6576.2011.02429.x CrossRefPubMed

15.

Marques EMR, Jones HE, Elvers KT et al (2014) Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness. BMC Musculoskelet Disord 15:220. doi:10.1186/1471-2474-15-220 CrossRefPubMedPubMedCentral

16.

McCarthy D, Iohom G (2012) Local infiltration analgesia for postoperative pain control following total hip arthroplasty: a systematic review. Anesthesiol Res Pract 2012:e709531. doi:10.1155/2012/709531

17.

Yin J-B, Cui G-B, Mi M-S et al (2014) Local infiltration analgesia for postoperative pain after hip arthroplasty: a systematic review and meta-analysis. J Pain 15:781–799. doi:10.1016/j.jpain.2014.03.002 CrossRefPubMed

18.

Chen DW, Hsieh P-H, Huang K-C et al (2010) Continuous intra-articular infusion of bupivacaine for postoperative pain relief after total hip arthroplasty: a randomized, placebo-controlled, double-blind study. Eur J Pain Lond Engl 14:529–534. doi:10.1016/j.ejpain.2009.08.008 CrossRef

19.

Andersen KV, Pfeiffer-Jensen M, Haraldsted V, Søballe K (2007) Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty: a randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients. Acta Orthop 78:180–186. doi:10.1080/17453670710013654 CrossRefPubMed

20.

Lunn TH, Husted H, Solgaard S et al (2011) Intraoperative local infiltration analgesia for early analgesia after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med 36:424–429. doi:10.1097/AAP.0b013e3182186866 CrossRefPubMed

21.

Gibon E, Courpied J-P, Hamadouche M (2013) Total joint replacement and blood loss: what is the best equation? Int Orthop 37:735–739. doi:10.1007/s00264-013-1801-0 CrossRefPubMedPubMedCentral

22.

Irisson E, Kerbaul F, Parratte S et al (2013) Perioperative management based on kinetics of bleeding during total primary arthroplasty. Ann Fr Anesth Rèanima 32:170–174. doi:10.1016/j.annfar.2012.12.005 CrossRef

23.

Lombardi AV, Berend KR, Mallory TH et al (2004) Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop :125–130

24.

Andersen KV, Nikolajsen L, Haraldsted V et al (2013) Local infiltration analgesia for total knee arthroplasty: should ketorolac be added? Br J Anaesth 111:242–248. doi:10.1093/bja/aet030 CrossRefPubMed

25.

Liu SS, Buvanendran A, Rathmell JP et al (2012) Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int Orthop 36:2261–2267. doi:10.1007/s00264-012-1623-5 CrossRefPubMedPubMedCentral

Title: Effect of local anaesthetic wound infiltration on acute pain and bleeding after primary total hip arthroplasty: the EDIPO randomised controlled study
Authors: Guillaume Villatte
Emilien Engels
Roger Erivan
Aurélien Mulliez
Nicolas Caumon
Stéphane Boisgard
Stéphane Descamps
Publication date: 01-11-2016
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 11/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-016-3133-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of local anaesthetic wound infiltration on acute pain and bleeding after primary total hip arthroplasty: the EDIPO randomised controlled study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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