title: Local infiltration analgesia is not improved by postoperative intra-articular bolus injections for pain after total hip arthroplasty.
abstract: OBJECTIVE
  The effect of postoperative intra-articular bolus injections after total hip arthroplasty (THA) remains unclear. We tested the hypothesis that intra-articular bolus injections administered every 6 hours after surgery during the first 24 hours would significantly improve analgesia after THA.
  
  
  METHODS
  80 patients undergoing THA received high-volume local infiltration analgesia (LIA; 200 mg ropivacaine and 30 mg ketorolac) followed by 4 intra-articular injections with either ropivacaine (100 mg) and ketorolac (15 mg) (the treatment group) or saline (the control group). The intra-articular injections were combined with 4 intravenous injections of either saline (treatment group) or 15 mg ketorolac (control group). All patients received morphine as patient-controlled analgesia (PCA). The primary outcome was consumption of intravenous morphine PCA and secondary outcomes were consumption of oral morphine, pain intensity, side effects, readiness for hospital discharge, length of hospital stay, and postoperative consumption of analgesics at 3, 6, and 12 weeks after surgery.
  
  
  RESULTS
  There were no statistically significant differences between the 2 groups regarding postoperative consumption of intravenous morphine PCA. Postoperative pain scores during walking were higher in the treatment group from 24-72 hours after surgery, but other pain scores were similar between groups. Time to readiness for hospital discharge was longer in the treatment group. Other secondary outcomes were similar between groups.
  
  
  CONCLUSIONS
  Postoperative intra-articular bolus injections of ropivacaine and ketorolac cannot be recommended as analgesic method after THA.
authors: a 1 Departments of Orthopedic Surgery.
authors: Karen V
authors: KV
authors: Andersen
authors: b 2 Anesthesiology , Aarhus University Hospital, Aarhus.
authors: Lone
authors: L
authors: Nikolajsen
authors: a 1 Departments of Orthopedic Surgery.
authors: Henrik
authors: H
authors: Daugaard
authors: c 3 Biostatistics Section, Department of Public Health, Aarhus University , Aarhus.
authors: Niels T
authors: NT
authors: Andersen
authors: b 2 Anesthesiology , Aarhus University Hospital, Aarhus.
authors: Viggo
authors: V
authors: Haraldsted
authors: a 1 Departments of Orthopedic Surgery.|d 4 The Lundbeck Foundation Center for Fast-Track Hip and Knee Arthroplasty , Denmark.
authors: Kjeld
authors: K
authors: Søballe
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007275:Injections, Intravenous; D020910:Ketorolac / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000700:Analgesics; D009020:Morphine; D000077212:Ropivacaine; D020910:Ketorolac