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The Efficacy of Periarticular Multimodal Drug Infiltration in Total Hip Arthroplasty

  • Clinical Research
  • Hip
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Patient-controlled analgesia is a widely used and effective method of controlling pain after THA. This method is associated with substantial undesirable side effects. Local infiltration has been introduced in an attempt to reduce opioid requirements postoperatively, but its ability to reduce pain without complications is still questioned.

Questions/Purposes

We evaluated patient-controlled analgesia use, pain and satisfaction scores, complication rates, and ropivacaine levels associated with the use of periarticular multimodal drug infiltration in THA.

Patients and Methods

We randomized 64 patients undergoing THA to receive a periarticular intraoperative multimodal drug injection or to receive no injection. All patients received patient-controlled analgesia for 24 hours after surgery. The final assessment was at 6 weeks.

Results

Patients receiving the periarticular injection used less patient-controlled analgesia 6 hours postoperatively. The 24-hour patient-controlled analgesia requirement postsurgery also was less. The visual analog scale score for pain on activity in the postanesthetic care unit was less for patients who received an injection. The visual analog scale satisfaction score was similar in the two groups throughout the followup period. Recorded unbound ropivacaine levels were 2.5 times lower than toxic levels.

Conclusions

Periarticular intraoperative injection with multimodal drugs can reduce postoperative patient-controlled analgesia requirements and pain on activity in patients undergoing THA with no apparent increase in risk.

Level of Evidence

Level I, therapeutic study. See the guidelines online for a complete description of level of evidence.

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Acknowledgments

We acknowledge Dr. L. Kohan and Dr. D. Kerr of Sydney, Australia, for their work in developing the multimodal drug combination used in this study. We also thank Prof C. H. Rorabeck and Dr. R. Bhandari for contributions to work with this research and the previous investigation of multimodal drug infiltration in TKAs.

Author information

Authors and Affiliations

  1. Ashford and St Peter’s Hospital NHS Trust, Chertsey, Surrey, England

    Constant A. Busch MB, BS, BSc (Hons), FRCS (Eng), FRCS (Tr and Orth)

  2. Bristol Implant Research Centre, Avon Orthopaedic Centre, Southmead Hospital, Bristol, BS10 5NB, England

    Michael R. Whitehouse MB, ChB, BSc (Hons), MSc (Orth Eng), MRCS (Eng)

  3. London Health Sciences Centre–University Campus, London, ON, Canada

    Benjamin J. Shore MD, Steven J. MacDonald MD, FRCSC, Richard W. McCalden MD, MPhil (Edin), FRCSC & Robert B. Bourne MD, FRCSC

Authors
  1. Constant A. Busch MB, BS, BSc (Hons), FRCS (Eng), FRCS (Tr and Orth)
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  2. Michael R. Whitehouse MB, ChB, BSc (Hons), MSc (Orth Eng), MRCS (Eng)
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  3. Benjamin J. Shore MD
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  4. Steven J. MacDonald MD, FRCSC
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  5. Richard W. McCalden MD, MPhil (Edin), FRCSC
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  6. Robert B. Bourne MD, FRCSC
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Corresponding author

Correspondence to Michael R. Whitehouse MB, ChB, BSc (Hons), MSc (Orth Eng), MRCS (Eng).

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at London Health Sciences Centre.

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Busch, C.A., Whitehouse, M.R., Shore, B.J. et al. The Efficacy of Periarticular Multimodal Drug Infiltration in Total Hip Arthroplasty. Clin Orthop Relat Res 468, 2152–2159 (2010). https://doi.org/10.1007/s11999-009-1198-7

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  • DOI: https://doi.org/10.1007/s11999-009-1198-7

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