title: A study of the usefulness of a periarticular multimodal drug cocktail injection for pain management after total hip arthroplasty.
abstract: BACKGROUND
  Measures for pain management after total hip arthroplasty (THA) are important for early improvement in the quality of life after operation and early postoperative rehabilitation. We investigated the analgesic effect of locally injected drugs around the total hip prosthesis.
  
  
  METHODS
  54 patients undergoing THA were randomized either to receive a periarticular intraoperative injection of a 30-ml mixture containing morphine hydrochloride 10 mg, 0.5% bupivacaine 20 ml, epinephrine 0.3 mg, and saline 8.7 ml or to receive no injection. The perioperative analgesic regimen was standardized. The evaluation items included assessment of pain using a 100-point visual analog scale (VAS) after the patients awoke on the day of the operation and on postoperative day 1, the dose of diclofenac sodium suppository, the number of days for acquiring assisted ambulation with a walking cane, and side effects.
  
  
  RESULTS
  The VAS score on the day of the operation was significantly low in the injection group. No cardiac or central nervous system toxicity was observed.
  
  
  CONCLUSIONS
  Intraoperative periarticular injection with multimodal drugs can significantly reduce pain on the day of the operation, with no apparent risks, following THA.
authors.affiliation: Department of Orthopaedic Surgery, Itami City Hospital, 1-100 Koyaike, Itami, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nakai
authors.affiliation: Department of Orthopaedic Surgery, Itami City Hospital, 1-100 Koyaike, Itami, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Orthopaedic Surgery, Itami City Hospital, 1-100 Koyaike, Itami, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Nakai
authors.affiliation: Department of Orthopaedic Surgery, Itami City Hospital, 1-100 Koyaike, Itami, Japan.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Onishi
authors.affiliation: Department of Orthopaedic Surgery, Itami City Hospital, 1-100 Koyaike, Itami, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Hashimoto
keywords: Pain control; Periarticular injection; Total hip arthroplasty