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Peri-articular injection of an analgesic mixture in primary total hip arthroplasty: an effective strategy for pain control during the first post-operative day

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Abstract

Background

Previous studies of soft tissue infiltration in hip arthroplasty present variable results. The purpose of this study is to identify whether injection of an analgesic mixture improves pain management during the immediate post-operative period.

Materials and methods

This cohort study compared 129 patients that received peri-articular soft tissue injection with 20 ml of 0.25% bupivacaine and 2 ml of ketorolac (30 mg/1 ml) in 28 ml of saline solution, with 71 patients who did not received injections. Pain intensity in the Verbal Analog Scale (VAS), opioid titration, and consumption (mg morphine equivalents) in the post-anaesthetic care unit (PACU) and during the first post-operative day were assessed for both groups. All patients received the same analgesia protocol.

Results

Median VAS score in the PACU was 4 (IQR 2–7) in the injection group and 7 (IQR 4–8) in the non-injection group (p = 0.001). Median opioid titration was 0 mg for the injection group and 2.6 mg for the non-injection group (p = 0.011). In the first post-operative day, the difference in VAS scores between groups was statistically significant (p = 0.009), but there was no difference in opioid consumption.

Conclusion

Soft tissue injection with local anesthetics and non-steroidal anti-inflammatory drugs allows adequate pain control in the immediate post-operative period and reduces the requirement for opioid consumption. We recommend the implementation of this safe and effective strategy in post-operative pain management after primary hip arthroplasty.

Level of evidence: Level II, cohort study.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, School of Medicine, Universidad del Rosario, Carrera 7 No. 117 – 15, Bogotá, Colombia

    Maria Bautista

  2. Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Carrera 7 No. 117 – 15, Bogotá, Colombia

    Meilyn Muskus

  3. Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, School of Medicine, Universidad de Los Andes, School of Medicine, Universidad del Rosario, Carrera 7 No. 117 – 15, Bogotá, Colombia

    Adolfo Llinás

  4. Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, School of Medicine, Universidad de Los Andes, School of Medicine, Universidad del Rosario, Carrera 7 No. 117 – 15, 110111186, Bogotá, Colombia

    Guillermo Bonilla

  5. Department of Anaesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, School of Medicine, Universidad El Bosque, Carrera 7 No. 117 – 15, Bogotá, Colombia

    Carlos Guerrero

  6. Department of Anaesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, School of Medicine, Universidad El Bosque, Carrera 7 No. 117 – 15, Bogotá, Colombia

    Jairo Moyano

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  1. Maria Bautista
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Corresponding author

Correspondence to Guillermo Bonilla.

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Conflict of interest

Maria Bautista MD MSc has received royalties for research support from a company or supplier as a Principal researcher for Grunenthal and has received financial support for attending symposia from De Puy Synthes (Orthopedics), outside this work. Meilyn Muskus MD declares that she has no conflict of interest. Adolfo Llinás MD has received royalties from Innomed, Novamed, and 3M; has participated as paid speaker for Zimmer, Shire, Novonordisk, Novartis, Johnson & Johnson, Medtronic and Procaps; has participated as paid consultant for Zimmer and Medtronic, outside this work. Guillermo Bonilla MD has participated as paid speaker for Boehringer-Ingelheim, Pfizer, Sanofi, and DePuy Synthes (Orthopedics); has received other financial support from DePuy Synthes (Orthopedics); and has received research support from a company or supplier as a Principal researcher for Grunenthal and Johnson & Johnson, outside this work. Carlos Guerrero MD has participated as paid speaker for Grunenthal, outside this work. Jairo Moyano MD MSc declares that he has no conflict of interest.

Ethical approval

Internal Review Board approval was granted to this protocol before it was initiated. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Bautista, M., Muskus, M., Llinás, A. et al. Peri-articular injection of an analgesic mixture in primary total hip arthroplasty: an effective strategy for pain control during the first post-operative day. International Orthopaedics (SICOT) 42, 1803–1810 (2018). https://doi.org/10.1007/s00264-018-3788-z

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  • DOI: https://doi.org/10.1007/s00264-018-3788-z

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