Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients.
BACKGROUND
We have developed a multimodal technique for the control of pain following knee and hip surgery, called "local infiltration analgesia" (LIA). It is based on systematic infiltration of a mixture of ropiva-caine, ketorolac, and adrenaline into the tissues around the surgical field to achieve satisfactory pain control with little physiological disturbance. The technique allows virtually immediate mobilization and earlier discharge from hospital.


METHODS
In this open, nonrandomized case series, we used LIA to manage postoperative pain in all 325 patients presenting to our service from Jan 1, 2005 to Dec 31,2006 for elective hip resurfacing (HRA), primary total hip replacement (THR), or primary total knee replacement arthroplasty (TKR). We recorded pain scores, mobilization times, and morphine usage for the entire group.


RESULTS
Pain control was generally satisfactory (numerical rating scale pain score range 0-3). No morphine was required for postoperative pain control in two-thirds of the patients. Most patients were able to walk with assistance between 5 and 6 h after surgery and independent mobility was achieved 13-22 h after surgery. Orthostatic hypotension, nausea, and vomiting were occasionally associated with standing for the first time, but other side effects were unremarkable. 230 (71%) of the 325 patients were discharged directly home after a single overnight stay in hospital.


CONCLUSIONS
Local infiltration analgesia is simple, practical, safe, and effective for pain management after knee and hip surgery.
Kerr
Dennis R
DR
Joint Orthopaedic Centre, New South Wales, Australia. drkerr@bigpond.net.au
Kohan
Lawrence
L
D000208:Acute Disease; D000577:Amides / Q000008:administration & dosage*; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000534:rehabilitation; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000534:rehabilitation; D016022:Case-Control Studies; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage; D004338:Drug Combinations; D004434:Early Ambulation; D004837:Epinephrine / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage*; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D012086:Reoperation; D000077212:Ropivacaine; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D016861:Cyclooxygenase Inhibitors; D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D009020:Morphine; D000077212:Ropivacaine; D004837:Epinephrine; D020910:Ketorolac