title: High-volume infiltration analgesia in bilateral hip arthroplasty. A randomized, double-blind placebo-controlled trial.
abstract: OBJECTIVE
  High-volume infiltration analgesia may be effective in postoperative pain management after hip arthroplasty but methodological problems prevent exact interpretation of previous studies.
  
  
  METHODS
  In a randomized, double-blind placebo-controlled trial in 12 patients undergoing bilateral total hip arthroplasty (THA) in a fast-track setting, saline or high-volume (170 mL) ropivacaine (0.2%) with epinephrine (1:100,000) was administered to the wound intraoperatively along with supplementary postoperative injections via an intraarticular epidural catheter. Oral analgesia was instituted preoperatively with a multimodal regimen (gabapentin, celecoxib, and acetaminophen). Pain was assessed repeatedly for 48 hours postoperatively, at rest and with 45° hip flexion.
  
  
  RESULTS
  Pain scores were low and similar between ropivacaine and saline administration. Median hospital stay was 4 (range 2-7) days. Interpretation Intraoperative high-volume infiltration with 0.2% ropivacaine with repeated intraarticular injections postoperatively may not give a clinically relevant analgesic effect in THA when combined with a multimodal oral analgesic regimen with gabapentin, celecoxib, and acetaminophen.
authors.affiliation: Department of Anesthesiology, Hvidovre Hospital, Copenhagen, Denmark lasseandersen@email.dk
authors.forename: Lasse Ø
authors.initials: LØ
authors.lastname: Andersen
authors.forename: Kristian S
authors.initials: KS
authors.lastname: Otte
authors.forename: Henrik
authors.initials: H
authors.lastname: Husted
authors.forename: Lissi
authors.initials: L
authors.lastname: Gaarn-Larsen
authors.forename: Billy
authors.initials: B
authors.lastname: Kristensen
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage; D000588:Amines / Q000008:administration & dosage; D000700:Analgesics / Q000008:administration & dosage*; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D000068579:Celecoxib; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D000077206:Gabapentin; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control; D011720:Pyrazoles / Q000008:administration & dosage; D000077212:Ropivacaine; D013449:Sulfonamides / Q000008:administration & dosage; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage
chemical_list: D000577:Amides; D000588:Amines; D000700:Analgesics; D000779:Anesthetics, Local; D003509:Cyclohexanecarboxylic Acids; D011720:Pyrazoles; D013449:Sulfonamides; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D000077212:Ropivacaine; D000068579:Celecoxib; D004837:Epinephrine