Fractures around the hip - post operative pain relief. comparison between spinal anesthesia with and without intraoperative periarticular local infiltration of drugs mixture

Abstract

Background: The incidence of hip fracture is increasing worldwide. Better postoperative pain relief in patients with hip fracture can be achieved with multimodal anaesthesia. Using intraoperative local infiltration of surgical site can achieve this goal efficiently and also it can reduce need of rescue doses of systemic analgesia and adverse outcomes associated with opioids. We endeavor to compare the analgesia produced in patients operated for fractures around hip under spinal anesthesia with and without intraoperative periarticular local infiltration with drug mixture.Material and Methods: A total of 60 patients were included in the study. 30 patients given spinal anaesthesia along with intraoperative local infiltration of mixture of drugs (Group A).30 patients given plane spinal anaesthesia (Group B).22 Gauge, 3.5 inches long needle used for local infiltration of mixture. Drug mixture used contained a combination of 300mg of ropivacaine, 30 mg of ketorolac and 0.5 mg epinephrine (approx.160 ml). Intraoperative as well as postoperative measurements and recordings were done with respect to haemodynamic parameters as heart rate, systolic and diastolic blood pressure change trends were recorded. Pain measurement was done using 10 point Visual Analogue Scale (VAS) score, and need for additional analgesia in form of tramadol and /or diclofenac injection.Result: The average scores on the VAS scores for both procedures were comparable except at 4 and 8 hours post-operatively, resulting in greater number of rescue analgesics in the Group B compared to Group A.Conclusion: For surgeries done around hip spinal anaesthesia with intraoperative periarticular local infiltration of drug mixture is a good option to efficiently control postoperative pain. This reduces the need of rescue analgesia and thus helps avoid the adverse-affects that are due to use of opioids in immediate postoperative period.