Abstract
Background and purpose Local infiltration analgesia (LIA) supports early mobilization after hip and knee arthroplasty. Inspired by this, we studied the effectiveness of wound infiltration with the long acting local anesthetic ropivacaine in an effort to decrease the need for postoperative opioids after osteosynthesis of extracapsular hip fracture. Methods Forty-nine patients undergoing osteosynthesis with a sliding hip screw were randomized into two groups in a double-blind study (ClinicalTrials.gov:NCT01119209). The patients received intraoperative infiltration followed by 6 postoperative injections through a wound catheter in eight-hour intervals. 23 patients received ropivacaine and 26 received saline. The intervention period was 2 days, and the observation period was 5 days. In both groups, there were no restrictions on the total daily dose of opioids. Pain was assessed at specific postoperative time points, and the daily opioid usage was registered. Results Intraoperative infiltration with 200 mg ropivacaine and postoperative repeated infiltration with 100 mg ropivacaine did not result in statistically significant difference between the groups regarding postoperative opioid consumption or pain. Interpretation Ropivacaine as single component in postoperative treatment of pain after hip fracture is not effective. In our setup, wound infiltration with ropivacaine is not statistically significantly better than placebo.
Highlights
Sufficient treatment of pain is essential for early postoperative rehabilitation after osteosynthesis of hip fractures.e final outcome after hip fracture may be impaired by undertreated pain [1], and conventional methods of pain treatment using paracetamol, systemic opioids, or specific nerve blocks are associated with well-known side effects [2, 3]
We present the data from a randomized clinical trial performed to assess the impact of local anesthetic wound infiltration with ropivacaine for postoperative pain relief after osteosynthesis of extracapsular hip fracture
We noticed that patients who received the planned spinal anesthesia and were allocated to ropivacaine infiltration showed a trend toward lower median consumption of rescue analgesia during the intervention period and the following day equivalent to 11 mg (≈2 standard rescue dosages) on the 1st postoperative day (POD 1) and 6 mg (≈1 standard rescue dosage) on the 2nd and 3rd postoperative days (POD 2) and (POD 3), compared to placebo (Figure 3)
Summary
Sufficient treatment of pain is essential for early postoperative rehabilitation after osteosynthesis of hip fractures.e final outcome after hip fracture may be impaired by undertreated pain [1], and conventional methods of pain treatment using paracetamol, systemic opioids, or specific nerve blocks are associated with well-known side effects (sedation, delirium, nausea, and urinary retention) [2, 3]. Sufficient treatment of pain is essential for early postoperative rehabilitation after osteosynthesis of hip fractures. Local infiltration analgesia (LIA) has proved effective for pain relief after knee arthroplasties [4]. We present the data from a randomized clinical trial performed to assess the impact of local anesthetic wound infiltration with ropivacaine for postoperative pain relief after osteosynthesis of extracapsular hip fracture. We studied the effectiveness of wound infiltration with the long acting local anesthetic ropivacaine in an effort to decrease the need for postoperative opioids after osteosynthesis of extracapsular hip fracture. Intraoperative infiltration with 200 mg ropivacaine and postoperative repeated infiltration with 100 mg ropivacaine did not result in statistically significant difference between the groups regarding postoperative opioid consumption or pain. Wound infiltration with ropivacaine is not statistically significantly better than placebo
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