Can a Periarticular Levobupivacaine Injection Reduce Postoperative Opiate Consumption During Primary Hip Arthroplasty?
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Several reports have confirmed the ability of intraoperative periarticular injections to control pain after THA. However, these studies used differing combinations of analgesic agents and the contribution of each, including the local anesthetic agent, is uncertain. Understanding the independent effects of the various agents could assist in improved pain management after surgery.
We therefore determined the ability of intraoperative periarticular infiltration of levobupivacaine to (1) reduce postoperative pain, (2) reduce postoperative morphine requirements, and (3) reduce the incidence of nausea and urinary retention.
Patients and Methods
A double-blinded, randomized, placebo-controlled trial of patients undergoing primary THAs was performed. Patients were randomized to receive a periarticular infiltration of 150 mg levobupivacaine in 60 mL 0.9% saline (n = 45) or a placebo consisting of 60 mL 0.9% saline (n = 46). We obtained a short-form McGill pain score, visual analog scale (VAS), and morphine requirements via patient-controlled analgesia (PCA) as primary measures. Postoperative antiemetic requirements and need for catheterization for urinary retention were determined as secondary measures.
Subjectively reported pain scores and the overall intensity scores were similar for both groups in the postoperative period. At the same time the mean morphine consumption was less in the levobupivacaine group, most notable in the first 12 hours after surgery: treatment group 11.5 mg vs control group 21.2 mg. We observed no differences in the frequency of postoperative nausea and vomiting or urinary retention.
Our observations suggest periarticular injection of levobupivacaine can supplement available postoperative analgesic techniques and reduce postoperative morphine requirements after THA.
Level of Evidence
Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Bird SB, Dickson EW. Clinically significant changes in pain along the visual analog scale. Ann Emerg Med. 2001;38:639–643. CrossRef
- Birnbaum K, Prescher A, Hepler S, Heller KD. The sensory innervation of the hip joint: an anatomical study. Surg Radiol Anat. 1997;19:371–375. CrossRef
- Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, Kvarstein G, Stubhaug A. Assessment of pain. Br J Anaesth. 2008;101:17–24. CrossRef
- Busch CA, Whitehouse MR, Shore BJ, MacDonald SJ, McCalden RW, Bourne RD. The efficacy of periarticular multimodal drug infiltration in total hip arthroplasty. Clin Orthop Relat Res. 2010;468:2152–2159. CrossRef
- Choi P, Bhandari M, Scott J, Douketis J. Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev. 2003;3:CD003071.
- Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs. 2000;59:551–579. CrossRef
- Frater RA, Moores MA, Parry P, Hanning CD. Analgesia-induced respiratory depression: comparison of meptazinol and morphine in the postoperative period. Br J Anaesth. 1989;63:260–265. CrossRef
- Gallagher EJ, Bijur PE, Latimer C, Silver W. Reliability and validity of a visual analog scale for acute abdominal pain in the ED. Am J Emerg Med. 2002;20:287–290. CrossRef
- Gedney JA, Liu EH. Side-effects of epidural infusions of opioid bupivacaine mixtures. Anaesthesia. 1998;53:1148–1155. CrossRef
- Goldstein H, Browne W, Rasbash J. Multilevel modelling of medical data. Stat Med. 2002;21:3291–3315. CrossRef
- Grant CR, Checketts MR. Analgesia for primary hip and knee arthroplasty: the role of regional anaesthesia. Contin Educ Anaesth Crit Care Pain. 2008;8:56–61. CrossRef
- Gristwood RW, Greaves JL. Levobupivacaine: a new safer long acting local anaesthetic agent. Expert Opin Investig Drugs. 1999;8:861–876. CrossRef
- Gwilym SE, Pollard TC, Carr AJ. Understanding pain in osteoarthritis. J Bone Joint Surg Br. 2008;90:280–287. CrossRef
- Horlocker TT. Pain management in total joint arthroplasty: a historical review. Orthopedics. 2010;33(9 suppl):14–19. CrossRef
- Lee KJ, Min BW, Bae KC, Cho CH, Kwon DH. Efficacy of multimodal pain control protocol in the setting of total hip arthroplasty. Clin Orthop Surg. 2009;1:155–160. CrossRef
- Leyland A, Groenewegen PP. Multilevel modelling and public health policy. Scand J Public Health. 2003;31:267–274. CrossRef
- McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum. 2001;45:453–461. CrossRef
- Melzack R. The short-form McGill Pain Questionnaire. Pain. 1987;30:191–197. CrossRef
- O’Connell AA, McCoach DB. Applications of hierarchical linear models for evaluations of health interventions: demystifying the methods and interpretations of multilevel models. Eval Health Prof. 2004;27:119–151. CrossRef
- Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty. 2007;22(6 suppl 2):33–38. CrossRef
- Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. 1998;87:88–92.
- Souron V, Delaunay L, Schifrine P. Intrathecal morphine provides better postoperative analgesia than psoas. Can J Anaesth. 2003;50:574–579. CrossRef
- Can a Periarticular Levobupivacaine Injection Reduce Postoperative Opiate Consumption During Primary Hip Arthroplasty?
Clinical Orthopaedics and Related Research®
Volume 470, Issue 4 , pp 1151-1157
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Cappagh National Orthopaedic Hospital, Dublin, Ireland
- 2. Orthopaedic Research and Innovation Foundation, Sports Surgery Clinic, Santry Demesne, Dublin D9, Ireland