Erector spinae plane block combined with local infiltration analgesia for total hip arthroplasty: A randomized, placebo controlled, clinical trial

Local infiltration analgesia (LIA) is an analgesic technique that has gained popularity since it was first brought to widespread attention by Kerr and Kohan in 2008. The technique involves the infiltration of a large volume dilute solution of a long-acting local anesthetic agent, often with adjuvants (e.g., epinephrine, ketorolac, an opioid), throughout the wound at the time of surgery. The analgesic effect duration can then be prolonged by the placement of a catheter to the surgical site for postoperative administration of further local anesthetic. The technique has been adopted for use for postoperative analgesia following a range of surgical procedures (orthopedic, general, gynecological, and breast surgeries). The primary objective of this paper was to determine, based on the current evidence, if LIA is superior when compared to no intervention, placebo, and alternative analgesic methods in patients following total hip arthroplasty, in terms of certain outcome measures. The outcomes considered were postoperative analgesia scores, joint function/rehabilitation, and length of hospital stay. Secondary objectives were to review available evidence and current knowledge regarding the pharmacokinetics of local anesthetic and adjuvant drugs when administered in this way and the occurrence of adverse events.

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Intraoperative Local Infiltration Analgesia for Early Analgesia After Total Hip Arthroplasty

Regional Anesthesia and Pain Medicine ◽

10.1097/aap.0b013e3182186866 ◽

2011 ◽

Vol 36 (5) ◽

pp. 424-429 ◽

Cited By ~ 68

Author(s):

Troels H. Lunn ◽

Henrik Husted ◽

Søren Solgaard ◽

Billy B. Kristensen ◽

Kristian S. Otte ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Local Infiltration Analgesia ◽

Local Infiltration ◽

Total Hip ◽

Infiltration Analgesia

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Local infiltration analgesia does not have benefits in fast-track hip arthroplasty programmes: a double-blind, randomised, placebo-controlled, clinical trial

Hip International ◽

10.1177/1120700021992684 ◽

2021 ◽

pp. 112070002199268

Author(s):

Marti Bernaus ◽

Marga Novellas ◽

Agustí Bartra ◽

Jorge H Núñez ◽

Francesc Anglès

Keyword(s):

Clinical Trial ◽

Hip Arthroplasty ◽

Fast Track ◽

Hip Osteoarthritis ◽

Multimodal Analgesia ◽

Controlled Clinical Trial ◽

Single Shot ◽

Local Infiltration Analgesia ◽

Local Infiltration ◽

Infiltration Analgesia

Background: Multimodal analgesia regimes including local infiltration analgesia (LIA) have been successfully applied in fast-track hip arthroplasty programmes. LIA’s contribution to the analgesic effect in hip arthroplasty has been questioned. Our study sought to determine the analgesic efficacy of LIA in THA surgery in a fast-track programme. Methods: Patients diagnosed with hip osteoarthritis scheduled for arthroplasty were randomised to receive LIA (120 ml ropivacaine 0.2% plus epinephrine 0.5 µ/ml) or saline as a part of a multimodal analgesia regime. The surgical team, the nursing staff, and patients were all blinded regarding patient allocation throughout the study. The primary outcome was pain assessed as a continuous variable using the visual analogue scale (VAS) at 4, 8, 24 and 48 hours postoperatively. Secondary outcomes included the amount of analgesic rescue consumption, complications and length of hospital stay. Results: A total of 63 patients were interviewed and agreed to participate in the study. No statistically significant differences were found between groups for pain measurements at 4, 8, 12, 24 and 48 hours after surgery. There were also no differences in rescue medication consumption, complications, or length of stay. Conclusions: Our results suggest LIA (ropivacaine plus epinephrine, single shot) has no effect in pain management and has not shown benefits for early ambulation in primary THA surgery. Further research is needed to establish the optimal multimodal analgesia regime for THA fast-track programmes. Clinical trial registration: Clinicaltrials.gov (NCT03513276).

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Local infiltration analgesia with bupivacaine and adrenaline does not reduce perioperative blood loss in total hip arthroplasty

PLoS ONE ◽

10.1371/journal.pone.0257202 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257202

Author(s):

Marcin Ceynowa ◽

Tomasz Sikora ◽

Marek Rocławski ◽

Mariusz Treder ◽

Krzysztof Kolarz ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Hip Arthroplasty ◽

Soft Tissues ◽

Blood Transfusions ◽

Local Infiltration Analgesia ◽

Local Infiltration ◽

Total Hip ◽

Perioperative Blood Loss ◽

Infiltration Analgesia

This study evaluates the effect of local infiltration analgesia with bupivacaine and adrenaline on perioperative blood loss in total hip arthroplasty. Patients who had primary total hip arthroplasty were retrospectively assigned to two groups. One group had 100 ml of bupivacaine/adrenaline solution injected into periarticular soft tissues at the end of the procedure. There were 55 patients in the infiltrated hip group and 44 patients in the not infiltrated group. Patients’ hemoglobin level (Hb), hematocrit (HTC), red blood count (RBC), platelet count (PLT) and International Normalized Ratio (INR) as well as the need for blood transfusions were compared statistically between groups preoperatively and postoperatively. There were no significant differences between Hb, HTC or RBC levels as well as the rate and amount of blood transfusions on the 1st, 4th postoperative days or at patients’ discharge between infiltrated and not infiltrated groups. This study does not support the hypothesis that the use of local infiltration analgesia with adrenaline may reduce perioperative blood loss in total hip arthroplasty.

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