Periarticular local anesthesia does not improve pain or mobility after THA

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Pain Management

Background:

• Periarticular infiltration with local anesthetics, NSAIDs, and adrenaline is known to reduce pain and improve recovery after total hip arthroplasty (THA).
• However, the specific efficacy of local anesthetic infiltration alone for these outcomes remains undetermined.

Purpose of the Study:

• To investigate whether periarticular injection of local anesthetic during THA alone can decrease postoperative pain and opioid use.
• To determine if it improves early postoperative mobility.

Main Methods:

• A randomized controlled trial involving 96 patients undergoing THA.
• The treatment group received levobupivacaine with adrenaline infiltration before wound closure; the control group did not.
• Postoperative pain, morphine consumption, and mobility (transfers, walking speed, stair negotiation) were assessed within 24 hours. Blinding was maintained for patients and physiotherapists.

Main Results:

• No significant differences were found in postoperative morphine consumption or stair negotiation ability between groups.
• The local anesthetic group reported increased pain between 7-12 hours postoperatively, with no other pain score differences.
• A modest improvement in walking speed over 6 meters was observed in the treatment group, but not over 10 meters.

Conclusions:

• Periarticular infiltration of local anesthetic alone during THA does not effectively reduce postoperative pain.
• It also fails to improve early postoperative mobility or reduce hospital stay.
• The findings suggest that combined approaches may be necessary for optimal pain and mobility outcomes post-THA.