title: Local infiltration analgesia followed by continuous infusion of local anesthetic solution for total hip arthroplasty: a prospective, randomized, double-blind, placebo-controlled study.
abstract: BACKGROUND
  We studied the efficacy of local infiltration analgesia in surgical wounds with 0.2% ropivacaine (50 mL), ketorolac (15 mg), and adrenaline (0.5 mg) compared with that of local infiltration analgesia combined with continuous infusion of 0.2% ropivacaine as a method of pain control after total hip arthroplasty. We hypothesized that as a component of multimodal analgesia, local infiltration analgesia followed by continuous infusion of ropivacaine would result in reduced postoperative opioid consumption and lower pain scores compared with infiltration alone, and that both of these techniques would be superior to placebo.
  
  
  METHODS
  In this prospective, double-blind, placebo-controlled study, 105 patients were randomized into three groups: Group I, in which patients received infiltration with ropivacaine, ketorolac, and adrenaline followed by continuous infusion of 0.2% ropivacaine at 5 mL/hr; Group II, in which patients received infiltration with ropivacaine, ketorolac, and adrenaline followed by continuous infusion of saline solution at 5 mL/hr; and Group III, in which patients received infiltration with saline solution followed by continuous infusion of saline solution at 5 mL/hr.All patients received celecoxib, pregabalin, and acetaminophen perioperatively and patient-controlled analgesia; surgery was performed under general anesthesia. Before wound closure, the tissues and periarticular space were infiltrated with ropivacaine, ketorolac, and adrenaline or saline solution and a fenestrated catheter was placed. The catheter was attached to a pump prefilled with either 0.2% ropivacaine or saline solution set to infuse at 5 mL/hr.The primary outcome measure was postoperative opioid consumption and the secondary outcome measures were pain scores, adverse side effects, and patient satisfaction.
  
  
  RESULTS
  There were no differences between groups in the administration of opioids in the operating room, in the recovery room, or on the surgical floor. The pain scores on recovery room admission and discharge and the floor were low and similar between groups. There were no differences in the incidence of adverse side effects among groups. Patient satisfaction with pain management was similar in all groups.
  
  
  CONCLUSIONS
  Local infiltration analgesia alone or followed by continuous infusion of ropivacaine as part of multimodal analgesia provides no additional analgesic benefit or reduction in opioid consumption compared with placebo following total hip arthroplasty.
  
  
  METHODS
  Therapeutic level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06032.
authors.forename: Olga
authors.initials: O
authors.lastname: Solovyova
authors.forename: Courtland G
authors.initials: CG
authors.lastname: Lewis
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Abrams
authors.forename: John
authors.initials: J
authors.lastname: Grady-Benson
authors.forename: Michael E
authors.initials: ME
authors.lastname: Joyce
authors.forename: Steven F
authors.initials: SF
authors.lastname: Schutzer
authors.forename: Sivasenthil
authors.initials: S
authors.lastname: Arumugam
authors.forename: Stephanie
authors.initials: S
authors.lastname: Caminiti
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Sinha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use; D000698:Analgesia / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D004311:Double-Blind Method; D004333:Drug Administration Routes; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D004837:Epinephrine; D020910:Ketorolac