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Continuous epicapsular infusion of anesthetic effective for post THA pain

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Use of a special wound catheter to infuse a local anesthetic directly into the joint of patients undergoing hip replacement yields “significant and lasting improvements” in postoperative pain control, according to a level 1 study published in Anesthesia & Analgesia.

According to a press release on the study, stopping the pain at the source produces lower pain scores, reduced morphine use and less nausea and vomiting.

“Moreover, a positive effect on superficial and deep wound pain was still present 3 months later,” researcher Jose Aguirre, MD, and colleagues wrote in the study.

Study methods

The investigators prospectively studied 76 consecutive patients who underwent minimally invasive hip replacement using spinal anesthesia. All patients, according to the release, received a specially designed wound catheter that was placed into the hip joint during the operation. Investigators randomized one group to receive an infusion of ropivacaine — inserted into the joint at the end of the procedure and for 48 hours postoperatively — and the other group to receive a continuous wound infusion with an inactive placebo solution.

Both groups were given access to patient-controlled morphine for pain relief. The investigators compared the groups in terms of pain scores and the amount of morphine used. They performed a 3-month postoperative follow-up of the patients.

Improvements in pain scores

According to the release, patients who received a continuous wound infusion of ropivacaine had better pain control during the first 48 hours postoperatively, and demonstrated lower scores for pain at rest and pain with motion. Morphine use reflected this, especially in the first 24 hours postoperatively. Overall, investigators discovered that patients in the ropivacaine group used 36% less morphine than those in the placebo group.

Less postoperative nausea and vomiting was also reported in the ropivacaine group.

The study noted that pain was reduced for the ropivacaine group 3 months postoperatively, as patients in that group displayed lower scores for superficial pain and deep pain.

“Continuous epicapsular wound infusion with ropivacaine 0.3% after minimally invasive hip replacement is an efficient technique for reducing morphine consumption and improving the quality of postoperative analgesia,” the authors wrote. “The beneficial effects of this technique are still present 3 months after surgery.”

Reference:

• Aguirre J, Baulig B, Dora C, et al. Continuous epicapsular ropivacaine 0.3% infusion after minimally invasive hip arthroplasty: A prospective, randomized, double-blinded, placebo-controlled study comparing continuous wound infusion with morphine patient-controlled analgesia. Anesth Analg. 2012. doi: 10.1213/ANE.0b013e318239dc64.

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