title: No effect of the infiltration of local anaesthetic for total hip arthroplasty using an anterior approach: a randomised placebo controlled trial.
abstract: Only limited data are available regarding the infiltration of local anaesthetic for total hip arthroplasty (THA), and no studies were performed for THA using the anterior approach. In this prospective, randomised placebo-controlled study we investigated the effect of both standard and reverse infiltration of local anaesthetic in combination with the anterior approach for THA. The primary endpoint was the mean numeric rating score for pain four hours post-operatively. In addition, we recorded the length of hospital stay, the operating time, the destination of the patient at discharge, the use of pain medication, the occurrence of side effects and pain scores at various times post-operatively. Between November 2012 and January 2014, 75 patients were included in the study. They were randomised into three groups: standard infiltration of local anaesthetic, reversed infiltration of local anaesthetic, and placebo. There was no difference in mean numeric rating score for pain four hours post-operatively (p = 0.87). There were significantly more side effects at one and eight hours post-operatively in the placebo group (p = 0.02; p = 0.03), but this did not influence the mobilisation of the patients. There were no differences in all other outcomes between the groups. We found no clinically relevant effect when the infiltration of local anaesthetic with ropivacaine and epinephrine was used in a multimodal pain protocol for THA using the anterior approach.
authors.affiliation: Reinier de Graaf Hospital, Postbus 5011, 2626 AD Delft, The Netherlands.
authors.forename: Y M
authors.initials: YM
authors.lastname: den Hartog
authors.affiliation: Reinier de Graaf Hospital, Postbus 5011, 2626 AD Delft, The Netherlands.
authors.forename: N M C
authors.initials: NM
authors.lastname: Mathijssen
authors.affiliation: Reinier de Graaf Hospital, Postbus 5011, 2626 AD Delft, The Netherlands.
authors.forename: N T
authors.initials: NT
authors.lastname: van Dasselaar
authors.affiliation: Reinier de Graaf Hospital, Postbus 5011, 2626 AD Delft, The Netherlands.
authors.forename: P N J
authors.initials: PN
authors.lastname: Langendijk
authors.affiliation: Reinier de Graaf Hospital, Postbus 5011, 2626 AD Delft, The Netherlands.
authors.forename: S B W
authors.initials: SB
authors.lastname: Vehmeijer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000493:pharmacokinetics*; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000493:pharmacokinetics*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000534:rehabilitation; D004837:Epinephrine / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D004837:Epinephrine
keywords: Anterior approach; Local infiltration analgesia; THA