title: Periarticular local anesthesia does not improve pain or mobility after THA.
abstract: BACKGROUND
  Periarticular infiltration of local anesthetic, NSAIDs, and adrenaline have been reported to reduce postoperative pain, improve mobility, and reduce hospital stay for patients having THAs, but available studies have not determined whether local anesthetic infiltration alone achieves similar improvements.
  
  
  OBJECTIVE
  We therefore asked whether periarticular injection of a local anesthetic during THA reduced postoperative pain and opioid requirements and improved postoperative mobility.
  
  
  METHODS
  We randomized 96 patients to either treatment (n = 50) or control groups (n = 46). Before wound closure, the treatment group received local infiltration of 160 mL of levobupivacaine with adrenaline. The control group received no local infiltration. We assessed postoperative morphine consumption and pain during the 24 hours after surgery. Mobilization was assessed 24 hours postoperatively with supine-to-sit and sit-to-stand transfers, timed 10-m walk test, and timed stair ascent and descent. Patients and assessing physiotherapists were blind to study status.
  
  
  RESULTS
  We observed no differences in postoperative morphine consumption, time to ascend and descend stairs, or ability to transfer between treatment and control groups. The treatment group reported more pain 7 to 12 hours postoperatively, but there were no differences in pain scores between groups at all other postoperative intervals. The treatment group showed increased postoperative walking speed greater than 6 m, but not greater than 10 m, compared with the control group.
  
  
  CONCLUSIONS
  Periarticular infiltration of local anesthetic during THA did not reduce postoperative pain or length of hospital stay and did not improve early postoperative mobilization.
authors.affiliation: Orthopaedic Outcomes Assessment Unit, Musgrave Park Hospital, Stockmans Lane, Belfast, BT9 7JB, Northern Ireland, UK.
authors.forename: I
authors.initials: I
authors.lastname: Dobie
authors.forename: D
authors.initials: D
authors.lastname: Bennett
authors.forename: D J
authors.initials: DJ
authors.lastname: Spence
authors.forename: J M
authors.initials: JM
authors.lastname: Murray
authors.forename: D E
authors.initials: DE
authors.lastname: Beverland
mesh_terms: D000322:Adrenergic Agonists / Q000008:administration & dosage; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D016009:Chi-Square Distribution; D004434:Early Ambulation; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009660:Northern Ireland; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D025341:Principal Component Analysis; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000322:Adrenergic Agonists; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077554:Levobupivacaine; D002045:Bupivacaine; D004837:Epinephrine