Comparison of the Effect of Different Local Analgesia Administration Techniques in Total Hip Arthroplasty: A Retrospective Comparative Cohort Study.

Akira Hashimoto,Sakumo Kii,Masaaki Mawatari,Atsushi Kawaguchi,Motoki Sonohata,Hirohito Hirata,Takahiro Ushida

doi:10.1155/2021/9914590

Abstract

Objective To improve postoperative pain management, several authors have described the use of periarticular injection (PAI) or intra-articular injection (IAI) following total hip arthroplasty (THA). However, no comparative studies examining the results between PAI and IAI following THA have been published. This study aimed to evaluate the analgesic and anti-inflammatory effects of PAI and IAI following THA. Methods This single-center, retrospective cohort study enrolled patients who underwent unilateral primary THA. A total of 278 patients (281 hips) were included in the final analyses, with 112 patients (113 hips) in the control group, 85 patients (87 hips) in the PAI group, and 81 patients (81 hips) in the IAI group. Numeric rating scale (NRS) scores and laboratory data were assessed preoperatively and on postoperative days (POD) 1 and 7. Results NRS scores, creatine phosphokinase, and C-reactive protein levels in the PAI and IAI groups were significantly lower than those in the control group on POD 1 and 7. D-dimer levels were significantly lower in the PAI and IAI groups than in the control group on POD 7. The white blood cell count was significantly higher in the PAI and IAI groups than in the control group on POD 1 and 7. Aspartate transaminase, alanine aminotransferase, blood urea nitrogen, and creatinine levels were within the reference ranges in all three groups at all time points. NRS scores and laboratory data showed no significant differences between the PAI and IAI groups at all time points. Conclusion PAI and IAI have equivalent analgesic and anti-inflammatory effects. Considering the technical challenges of PAI, IAI may be preferable because of its simplicity in the case of using a closed suction drain.

Highlights

Total hip arthroplasty (THA) is one of the most successful orthopedic procedures for patients with hip osteoarthritis
Pre- and postoperative Numeric rating scale (NRS) scores showed no significant differences between the periarticular injection (PAI) and intra-articular injection (IAI) groups (Table 2, Figure 1(a)). e proportion of patients in the control, PAI, and IAI groups who achieved the minimal clinically important difference (MCID) on postoperative days (POD) 1 was 35.4%, 71.3%, and 61.7%, respectively, whereas the proportion of patients in the control, PAI, and IAI groups who achieved the MCID on POD 7 was 78.8%, 88.5%, and 91.4%, respectively (Table 3)
Preoperative C-reactive protein (CRP) levels showed no significant differences among the three groups (Table 4, Figure 2(g)). e CRP levels were lower in the PAI and IAI groups than in the control group on POD 1 and POD 7, with no significant differences in CRP levels between the PAI and IAI groups (Tables 5 and 6, Figure 2(g)). e D-dimer levels showed no significant differences among the three groups preoperatively and on POD 1 (Tables 4 and 5, Figure 2(h)). e D-dimer levels were significantly lower in the PAI and IAI groups than in the control group on POD 7, with no significant differences in D-dimer levels between the PAI and IAI groups (Table 6, Figure 2(h)). e aspartate transaminase (AST), ALT, blood urea nitrogen (BUN), and Cr levels were within

Summary

Objective

To improve postoperative pain management, several authors have described the use of periarticular injection (PAI) or intra-articular injection (IAI) following total hip arthroplasty (THA). No comparative studies examining the results between PAI and IAI following THA have been published. Is study aimed to evaluate the analgesic and anti-inflammatory effects of PAI and IAI following THA. NRS scores, creatine phosphokinase, and C-reactive protein levels in the PAI and IAI groups were significantly lower than those in the control group on POD 1 and 7. D-dimer levels were significantly lower in the PAI and IAI groups than in the control group on POD 7. E white blood cell count was significantly higher in the PAI and IAI groups than in the control group on POD 1 and 7. NRS scores and laboratory data showed no significant differences between the PAI and IAI groups at all time points. PAI and IAI have equivalent analgesic and anti-inflammatory effects. Considering the technical challenges of PAI, IAI may be preferable because of its simplicity in the case of using a closed suction drain

Introduction

Results and Discussion

Conclusions