Abstract
Postoperative pain after hip arthroplasty (HA) is very common and severe. Currently,
use of routine analgesic methods is often accompanied by adverse events (AEs). Local
infiltration analgesia (LIA) for controlling pain has been a therapeutic option in
many surgical procedures. However, its analgesic efficacy in HA and its safety remain
unclear. Data from 9 randomized controlled trials, involving 760 participants, comparing
the effect of LIA with that of placebo infiltration or no infiltration on patients
undergoing HA were retrieved from an electronic database, and the pain scores, analgesic
consumption, and AEs were analyzed. Effects were summarized using weighted mean differences,
standardized mean differences, or odds ratio with fixed or random effect models. There
was strong evidence of an association between LIA and reduced pain scores at 4 hours
at rest (P < .00001) and with motion (P < .00001), 6 hours with motion (P = .02), and 24 hours at rest (P = .01), and decreased analgesic consumption during 0 to 24 hours (P = .001) after HA. These analgesic efficacies for LIA were not accompanied by any
increased risk for AEs. However, the current meta-analysis did not reveal any associations
between LIA and the reduced pain scores or analgesic consumption at other time points.
The results suggest that LIA can be used for controlling pain after HA because of
its efficacy in reducing pain scores and thus can reduce analgesic consumption on
the first day without increased risk of AEs.
Perspective
This is the first pooled database meta-analysis to assess the analgesic effects and
safety of LIA in controlling pain after HA. The derived information offers direct
evidence that LIA can be used for patients undergoing HA because of its ability to
reduce pain scores and analgesic consumption without any additional AEs.
Key words
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References
- 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. 2012; 114: 456-461
- Local infiltration analgesia for total knee arthroplasty: Should ketorolac be added?.Br J Anaesth. 2013; 111: 242-248
- 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. 2007; 78: 180-186
- Postoperative analgesia in total hip arthroplasty: A randomized double-blinded, placebo-controlled study on preoperative and postoperative ropivacaine, ketorolac, and adrenaline wound infiltration.Acta Orthop. 2007; 78: 187-192
- Analgesic efficacy of local anaesthetic wound administration in knee arthroplasty: Volume vs concentration.Anaesthesia. 2010; 65: 984-990
- High-volume infiltration analgesia in bilateral hip arthroplasty. A randomized, double-blind placebo-controlled trial.Acta Orthop. 2011; 82: 423-426
- The Cochrane Collaboration. Preparing, maintaining, and disseminating systematic reviews of the effects of health care.JAMA. 1995; 274: 1935-1938
- Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery.Br J Anaesth. 2003; 91: 830-835
- Evolution and current status of pain programs.J Pain Symptom Manage. 1990; 5: 368-374
- Comparing preincisional with postincisional bupivacaine infiltration in the management of postoperative pain.Arch Surg. 1997; 132: 766-769
- The efficacy of periarticular multimodal drug infiltration in total hip arthroplasty.Clin Orthop Relat Res. 2010; 468: 2152-2159
- Continuous intra-articular infusion of bupivacaine for post-operative pain relief after total hip arthroplasty: A randomized, placebo-controlled, double-blind study.Eur J Pain. 2010; 14: 529-534
- Epidural analgesia for pain relief following hip or knee replacement.Cochrane Database Syst Rev. 2003; : CD003071
- Statistical power analysis for the behavioral sciences.2nd ed. Lawrence Erlbaum Associates, Hillsdale, NJ1988
- Intra-articular local anaesthesia for pain after hip arthroplasty.J Bone Joint Surg Br. 1997; 79: 796-800
- Periarticular local anesthesia does not improve pain or mobility after THA.Clin Orthop Relat Res. 2012; 470: 1958-1965
- Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty.Acta Orthop. 2010; 81: 354-360
- A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement.Anaesthesia. 2005; 60: 1189-1202
- The analgesic efficacy of patient-controlled ropivacaine instillation after cesarean delivery.Anesth Analg. 2000; 91: 1436-1440
- Wound/intra-articular infiltration or peripheral nerve blocks for orthopedic joint surgery: Efficacy and safety issues.Curr Opin Anaesthesiol. 2012; 25: 615-620
- Bupivacaine wound infiltration in thyroid surgery reduces postoperative pain and opioid demand.Acta Anaesthesiol Scand. 1994; 38: 813-815
- A comprehensive anesthesia protocol that emphasizes peripheral nerve blockade for total knee and total hip arthroplasty.J Bone Joint Surg Am. 2005; 87: 63-70
- Higgins J.P. Deeks J.J. Altman D.G. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration, Baltimore, MD2011
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558
- Wound infiltration and drain lavage with ropivacaine after major shoulder surgery.Anesth Analg. 1999; 89: 1461-1466
- Estimating the mean and variance from the median, range, and the size of a sample.BMC Med Res Methodol. 2005; 5: 13
- A comparison of regional and general anaesthesia for total replacement of the hip or knee: A meta-analysis.J Bone Joint Surg Br. 2009; 91: 935-942
- Enhanced recovery in total hip replacement: A clinical review.Bone Joint J. 2013; 95-B: 1587-1594
- The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty.Anesth Analg. 2010; 111: 1552-1554
- Regional anesthesia in hip surgery.Clin Orthop Relat Res. 2005; 441: 250-255
- Assessing the quality of reports of randomized clinical trials: Is blinding necessary?.Control Clin Trials. 1996; 17: 1-12
- Local infiltration analgesia in joint replacement: The evidence and recommendations for clinical practice.Acta Anaesthesiol Scand. 2011; 55: 778-784
- 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. 2008; 79: 174-183
- Assessing the amount of heterogeneity in random-effects meta-analysis.Biom J. 2006; 48: 271-285
- Effect of ropivacaine on cutaneous capillary blood flow in pigs.Anesthesiology. 1989; 71: 69-74
- Postoperative pain relief after total hip arthroplasty: A randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia.Br J Anaesth. 2013; 111: 793-799
- Reduced opioid consumption and improved early rehabilitation with local and intraarticular cocktail analgesic injection in total hip arthroplasty: A randomized controlled clinical trial.Pain Med. 2011; 12: 387-393
- Intraoperative local infiltration analgesia for early analgesia after total hip arthroplasty: A randomized, double-blind, placebo-controlled trial.Reg Anesth Pain Med. 2011; 36: 424-429
- The effect of continuous epidural analgesia on postoperative pain, rehabilitation, and duration of hospitalization in total knee arthroplasty.Clin Orthop Relat Res. 1990; : 30-37
- Local infiltration analgesia for postoperative pain control following total hip arthroplasty: A systematic review.Anesthesiol Res Pract. 2012; 2012: 709531
- Improving the quality of reports of meta-analyses of randomised controlled trials: The QUOROM statement. Quality of Reporting of Meta-analyses.Lancet. 1999; 354: 1896-1900
- The role of epidural anesthesia and analgesia in surgical practice.Ann Surg. 2003; 238: 663-673
- Nerve growth factor governs the enhanced ability of opioids to suppress inflammatory pain.Brain. 2007; 130: 502-513
- Can a periarticular levobupivacaine injection reduce postoperative opiate consumption during primary hip arthroplasty?.Clin Orthop Relat Res. 2012; 470: 1151-1157
- A fail-safe N for effect size in meta-analysis.J Educ Stat. 1983; 8: 157
- Periarticular infiltration for pain relief after total hip arthroplasty: A comparison with epidural and PCA analgesia.Arch Orthop Trauma Surg. 2013; 133: 1607-1612
- The effects of incisional bupivacaine on postoperative narcotic requirements, oxygen saturation and length of stay in the post-anesthesia care unit.Acta Anaesthesiol Scand. 1990; 34: 486-491
- Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: A prospective randomized study.J Arthroplasty. 2007; 22: 33-38
- High-dose ropivacaine wound infiltration for pain relief after inguinal hernia repair: A clinical and pharmacokinetic evaluation.Reg Anesth Pain Med. 1998; 23: 189-196
- The use of epidural bupivacaine following total knee arthroplasty.Orthop Rev. 1989; 18: 894-901
- Survey of postoperative analgesia following ambulatory surgery.Acta Anaesthesiol Scand. 1997; 41: 1017-1022
- Local infiltration analgesia with levobupivacaine compared with intrathecal morphine in total hip arthroplasty patients.Acta Anaesthesiol Scand. 2012; 56: 695-705
- The file drawer problem and tolerance for null results.Psychol Bull. 1979; 86: 638-641
- Acute toxicity of ropivacaine compared with that of bupivacaine.Anesth Analg. 1989; 69: 563-569
- Local infiltration analgesia followed by continuous infusion of local anesthetic solution for total hip arthroplasty: A prospective, randomized, double-blind, placebo-controlled study.J Bone Joint Surg Am. 2013; 95: 1935-1941
- No evidence of a clinically important effect of adding local infusion analgesia administrated through a catheter in pain treatment after total hip arthroplasty.Acta Orthop. 2011; 82: 315-320
- Attacking pain at its source: New perspectives on opioids.Nat Med. 2003; 9: 1003-1008
- Postoperative analgesia: Economics, resource use, and patient satisfaction in an urban teaching hospital.Anesth Analg. 2002; 94 (table of contents): 130-137
- Adjusting for publication bias in the presence of heterogeneity.Stat Med. 2003; 22: 2113-2126
- Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review group.Spine (Phila Pa 1976). 2003; 28: 1290-1299
- Observation of the efficacy of local multimodal analgesic drugs injection in total hip arthroplasty.Zhongguo Gu Shang. 2008; 21: 834-836
- Minimally invasive surgical approaches and traditional total hip arthroplasty: A meta-analysis of radiological and complications outcomes.PLoS One. 2012; 7: e37947
Article info
Publication history
Published online: April 07, 2014
Footnotes
J.-B.Y., G.-B.C., and M.-S.M. contributed equally to this work.
Partly supported by the Innovation International Science & Technology Cooperation Program of China (2011DFA32560, to S.-X.W.), Program for Shaanxi Province Key Research Team of Science and Technology Innovation (2012KCT-14, to S.-X.W.), the Natural Key Plan of Shaanxi province (2008K13-04, to G.-B.C.), intramural grant of the Fourth Military Medical University (to W.W.).
There are no conflicts of interests including finance, honoraria, travel to conferences, consultancies, stock ownership, and equity interests.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
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© 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.
