title: The efficacy of periarticular multimodal drug infiltration in total hip arthroplasty.
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.
  
  
  OBJECTIVE
  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.
  
  
  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.
  
  
  METHODS
  Level I, therapeutic study. See the guidelines online for a complete description of level of evidence.
authors.affiliation: Ashford and St Peter's Hospital NHS Trust, Chertsey, Surrey, England.
authors.forename: Constant A
authors.initials: CA
authors.lastname: Busch
authors.forename: Michael R
authors.initials: MR
authors.lastname: Whitehouse
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Shore
authors.forename: Steven J
authors.initials: SJ
authors.lastname: MacDonald
authors.forename: Richard W
authors.initials: RW
authors.lastname: McCalden
authors.forename: Robert B
authors.initials: RB
authors.lastname: Bourne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000627:therapeutic use; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation; D004338:Drug Combinations; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006304:Health Status; D006801:Humans; D007270:Injections, Intra-Articular; D020910:Ketorolac / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000601:surgery; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D000077212:Ropivacaine; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D009020:Morphine; D000077212:Ropivacaine; D004837:Epinephrine; D020910:Ketorolac