Local infiltration analgesia with 0.2% ropivacaine may not improve recovery 1 day after anterior total hip arthroplasty surgery in adult patients with osteoarthritis, according to study results published in Anesthesia & Analgesia.
Patients scheduled to undergo primary unilateral anterior total hip arthroplasty for osteoarthritis were recruited from a tertiary level private hospital in an Australian metropolitan area and randomly assigned to receive local infiltration analgesia with 0.2% ropivacaine (2.5 mL/kg; n=74) or 0.9% saline placebo (n=78). Spinal anesthesia and oral multimodal analgesia were administered before surgery. Recovery on postoperative day 1 was evaluated using a multidimensional patient-reported Quality of Recovery-15 (QoR-15) scale, which includes measures of pain, physical comfort, physical independence, emotions, and psychological support. Opioid consumption after operation was also assessed.
On postoperative day 1, scores on the QoR-15 were comparable in patients receiving ropivacaine vs saline (median interquartile range [IQR], 119.5 [range, 102-124] vs 115 [range, 98-126], respectively; median difference, 2 [95% CI, −4 to 7]; P =.56).
Worst pain, assessed with scores on a numeric rating scale, was comparable in patients receiving local infiltration analgesia with ropivacaine vs saline at rest (scores, 3 vs 3.5, respectively; P =.57) and on movement (scores, 5 vs 5, respectively; P =.71). Patients receiving ropivacaine vs saline also had comparable opioid consumption, as measured with oral morphine equivalents on postoperative days 1 (55 vs 61.5 mg/d, respectively; P =.08) and 2 (29 vs 25 mg/d, respectively; P =.9), 10-minute walking time (31 vs 24 seconds, respectively; P =.45), brief pain inventory interference on postoperative day 90 (0.71 vs 0, respectively; P =.25), and length of hospital stay (4.1 days vs 4.0 days, respectively; P =.57). A similar percentage of patients who had received ropivacaine vs placebo were taking any opioid at postoperative day 30 (15% vs 18%, respectively; risk ratio [RR], 0.83; 95% CI, 0.40-1.7; P =.67) and at postoperative day 90 (4% vs 3%, respectively; RR, 1.6; 95% CI, 0.27-9.2; P =.61).
Study limitations include the small sample size and the recruitment of patients from a single urban center in Australia.
The authors concluded that their findings “The results of our study strengthen the evidence that [local infiltration analgesia] is not beneficial after anterior [total hip arthroplasty].”
Tan NL, Gotmaker R, Barrington MJ. Impact of local infiltration analgesia on the quality of recovery after anterior total hip arthroplasty: a randomized, triple-blind, placebo-controlled trial [published online June 3, 2019]. Anesth Analg. doi: 10.1213/ANE.0000000000004255