Anesthesia and acute pain management for minimally invasive hip surgery

Abstract

I g p n the United States, about 250,000 patients annually undergo a total hip replacement (THR). After a THR, the averge length of acute care hospitalization is 3.5 to 4 days followed ypically by a transfer to a rehabilitation center for more extenive physical therapy to optimize the functional recovery. For a HR, the traditional surgical technique, involving a skin inciion of at least 12 cm, is associated with significant trauma to he hip muscles and capsule. A recent focus on minimizing the ize of the incision as well as the associated surgical trauma is ased on an expectation that such changes might result in horter hospitalization, more rapid functional recovery, and a educed need for rehabilitative services. Among the diverse attempts to “minimize” the surgical rauma of hip replacement, two general types of procedure are ecognized. The first, a “mini” technique, refers to the use of a educed incision, ranging in length from 6 to 10 cm, compared ith 12 to 20 cm for a traditional approach. Deep to the cutaeous incision, however, a conventional surgical approach is ndertaken. “Mini” incisions include posterolateral, anterolatral, and true anterior approaches.1 From the perspectives of osmesis and marketing, those modifications are attractive; here are, however, no available clinical data to provide conincing evidence that a relevant patient achieves more rapid ecovery or a shorter period of convalescence in the hospital. he second technique is a “minimally invasive technique” and efers to the use of either one or two even smaller incisions and dissection designed to be performed between the muscles non muscle-splitting). While one or two small capsular inciions are necessary, the capsule is preserved and potentially epaired as part of the surgical closure.2 Concomitantly, altertions have been made in the orthopedic anesthesia and postperative analgesic techniques. One example is the use of a ontinuous lumbar plexus catheter infusing a local anesthetic, uch as ropivacaine. The majority of patients who undergo a inimally invasive THR are discharged directly from the hosital to their homes, either on the day of surgery or within 24 ours after the procedure. A costly admission to a rehabilitation