J Korean Hip Soc.  2010 Dec;22(4):266-272. 10.5371/jkhs.2010.22.4.266.

The Efficacy of a Periarticular Soft Tissue Injection of Bupivacaine and Morphine in Total Hip Arthroplasty: a Prospective Study

• Hwang KT
• Cho CM
• Kim YS
• Shim JH
• Kim YH

• KMID: 1461181
• DOI: http://doi.org/10.5371/jkhs.2010.22.4.266

Abstract

PURPOSE
We wanted to assess the benefits and safety of periarticular soft tissue injection of bupivacaine and morphine in total hip arthroplasty by conducting a prospective randomized trial.
MATERIALS AND METHODS
Between February 2008 and January 2010, a prospective, randomized study was performed on fifty patients with an American Society of Anesthesiology stage of I or II. All the patients were administered COX-2 inhibitor and we used PCEA (Patient Controlled Epidural Analgesia) for 24 hours postoperatively. All the patients underwent their operation under general anesthesia. Fifty randomly selected patients were divided into two groups. After reduction of the hip joint, 50 ml of normal saline was intraoperatively injected into 25 patients (Group A) and 50 ml of locally injected analgesia that included 0.5 ml 5 mg of morphine HCL, 40 ml of 0.5% 50 mg chirocaine (Levo-bupivacaine) and 9.5 ml of normal saline was injected into the capsule and the soft tissue and muscle around the hip joint in 25 patients (Group B). The analgesic efficacy was evaluated by the visual analogue scale (VAS) at 6 and 12 hours postoperatively with the patients in a resting state and at 24, 48 and 72 hours postoperatively with the patients in a resting state and during a passive exercise (30degrees) state. The consumption of PCEA and additional analgesic drugs was also evaluated postoperatively.
RESULTS
Significant differences were found between the 2 groups (P<0.05) with regard to the VAS at 6 and 12 hours postoperatively with the patients in a resting state and at 24, 48 and 72 hours postoperatively with the patients in a resting state and a passive exercise state. During 24 hours postoperatively, in the mixed analgesia injected group, the consumption of PCEA was significantly lower than that in the normal saline injected group (P<0.05). No significant differences were found for the consumption of additional analgesic drugs between the 2 groups (P>0.05).
CONCLUSION
Intraoperative periarticular soft tissue injection of bupivacaine and morphine can significantly reduce pain and it can reduce the requirement for patient-controlled analgesia, with no apparent risks, following total hip arthroplasty.

Keyword

Periarticular soft tissue injection; Bupivacaine; Morphine; Total hip arthroplasty

MeSH Terms

Analgesia
Analgesia, Patient-Controlled
Analgesics
Anesthesia, General
Anesthesiology
Arthroplasty
Bupivacaine
Hip
Hip Joint
Humans
Morphine
Muscles
Prospective Studies
Analgesics
Bupivacaine
Morphine

Figure

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  Fig. 1 Visual analogue scales (mean±SD) at 6, 12 hours postoperatively in rest state show significant differences between two groups.

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  Fig. 2 Visual analogue scales (mean±SD) at 24, 48, 72 hours postoperatively in rest show significant differences between two groups.

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  Fig. 3 Visual analogue scales (mean±SD) at 24, 48, 72 hours postoperatively in passive exercise state (30 degrees flexion) show significant differences between two groups.

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  Fig. 4 Consumption of patient controlled epidural analgesia (PCEA) shows significant differences between two groups for 24 hours postoperatively.

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