Local infiltration analgesia may decrease pain, opioid consumption after THA
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Published results showed use of local infiltration analgesia as an adjuvant therapy to spinal anesthesia may decrease pain and the need for opioid consumption after total hip arthroplasty.
“[Local infiltration analgesia] may be a good adjuvant therapy to spinal anesthesia in THA patients, as it may improve the postoperative experience by decreasing pain and nausea scores and thus the need for opioid consumption,” the authors wrote.
Researchers randomly assigned 152 patients undergoing elective THA through the direct anterior approach to receive spinal anesthesia alone (control group; n=53), spinal anesthesia with local infiltration analgesia perioperatively (n=50) or spinal anesthesia with fascia iliaca compartment block on the recovery unit (n=49). Outcome measures included postoperative pain scores, postoperative pain, nausea and vomiting, length of hospital stay, opioid requirements and mobility.
Results showed all patient groups had low overall pain scores, with lower pain scores in the local infiltration analgesia group vs. the control group until 4 hours postoperatively. Researchers found no significant differences between groups in length of hospital stay, postoperative pain, nausea and vomiting scores and quadriceps muscle strength. Although the control group had higher scores regarding rehabilitation potential, use of walking aids and activities of daily living at 12 hours postoperatively vs. the fascia iliaca compartment block group, researchers noted all groups reached the same endpoint at 48 hours postoperatively. Patients in the local infiltration analgesia group and the fascia iliaca compartment block group required less opioids until 24 hours postoperatively, according to results.
Perspective
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The adoption of multimodal pain management techniques has facilitated rapid recovery after THA. The combination of preoperative, intraoperative and postoperative pain management strategies has allowed surgeons to decrease pain, minimize patient narcotic requirements, enhance early ambulation and has enabled the majority of patients undergoing direct anterior approach THA to discharge home within 23 hours of surgery. The optimal methods of intraoperative pain control were investigated in this study, in which the authors conducted a prospective, randomized clinical trial comparing the adjuvant use of fascia iliaca compartment blocks or local infiltration analgesia to patients receiving spinal anesthesia alone for direct anterior approach THA. Local infiltration of an anesthetic cocktail by the surgeon was the most effective technique for decreasing pain and improving early ambulation. The fascia iliaca block was associated with a temporary motor blockade within the first 24 hours of surgery, although it also decreased postoperative pain compared with the spinal anesthesia control group. The authors do not provide outcomes comparing the cost of each of the anesthetic methods to determine cost-effectiveness, although given the low cost of the local infiltrative anesthetic technique, this result would only strengthen the recommendation that all direct anterior approach THA surgeons incorporate a local infiltrative anesthetic cocktail to benefit patients.
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