title: Periarticular infiltration for pain relief after total hip arthroplasty: a comparison with epidural and PCA analgesia.
abstract: OBJECTIVE
  Epidural and intravenous patient-controlled analgesia (PCA) are established methods for pain relief after total hip arthroplasty (THA). Periarticular infiltration is an alternative method that is gaining ground due to its simplicity and safety. Our study aims to assess the efficacy of periarticular infiltration in pain relief after THA.
  
  
  METHODS
  Sixty-three patients undergoing THA under spinal anaesthesia were randomly assigned to receive postoperative analgesia with continuous epidural infusion with ropivacaine (epidural group), intraoperative periarticular infiltration with ropivacaine, clonidine, morphine, epinephrine and corticosteroids (infiltration group) or PCA with morphine (PCA group). PCA morphine provided rescue analgesia in all groups. We recorded morphine consumption, visual analog scale (VAS) scores at rest and movement, blood loss from wound drainage, mean arterial pressure (MAP) and adverse effects at 1, 6, 12, 24 h postoperatively.
  
  
  RESULTS
  Morphine consumption at all time points, VAS scores at rest, 6, 12 and 24 h and at movement, 6 and 12 h postoperatively were lower in infiltration group compared to PCA group (p < 0.05), but did not differ between infiltration and epidural group. There was no difference in adverse events in all groups. At 24 h, MAP was higher in the PCA group (p < 0.05) and blood loss was lower in the infiltration group (p < 0.05).
  
  
  CONCLUSIONS
  In our study periarticular infiltration was clearly superior to PCA with morphine after THA, providing better pain relief and lower opioid consumption postoperatively. Infiltration seems to be equally effective to epidural analgesia without having the potential side effects of the latter.
authors.affiliation: 2nd Department of Anaesthesiology, School of Medicine, Attikon University Hospital, University of Athens, 1 Rimini Street, 12462, Athens, Greece, angpant@med.uoa.gr.
authors.forename: Ageliki
authors.initials: A
authors.lastname: Pandazi
authors.forename: Ilias
authors.initials: I
authors.lastname: Kanellopoulos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kalimeris
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Batistaki
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Nikolakopoulos
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Matsota
authors.forename: George C
authors.initials: GC
authors.lastname: Babis
authors.forename: Georgia
authors.initials: G
authors.lastname: Kostopanagiotou
mesh_terms: D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000772:Anesthesia, Local / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006621:Hip Joint; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine