J Korean Hip Soc.  2010 Dec;22(4):273-282. 10.5371/jkhs.2010.22.4.273.

Pain Control after Total Hip Replacement Arthroplasty Using Periarticular Multimodal Drug Injection

• Choi JS
• Kim JH
• Gwak HC
• Kim JW
• Min YK

• KMID: 1461182
• DOI: http://doi.org/10.5371/jkhs.2010.22.4.273

Abstract

PURPOSE
This study attempted to evaluate the pattern of change of the pain after total hip arthroplasty (THA) and to confirm the effect of periarticular multimodal drug injection (PMDI) on controlling the early postoperative pain.
MATERIALS AND METHODS
Of the total patients who underwent primary THA at our hospital because of osteonecrosis of the femoral head from March to October 2008, 60 patients were enrolled in this study. The subjects were divided into three groups. Groups 1 & 2 received periarticular injection. Group 1 included the patients who were injected with a combination of opioid, long-acting local anesthetics, a non-steroidal anti-inflammatory drug and epinephrine. Group 2 received a combination of morphine and ropivacaine and group 3 was not injected with any analgesics. The visual analogue scale (VAS) at 4 hours, 8 hours, 12 hours, 24 hours, 2 days, 3 days, 5 days, 14 days and 1 month after surgery, the frequency that patients pushed the self-controlled pain medication machine for 2 days after surgery and the amount of clonac that was injected according to the needs of the patients were used as objective measures.
RESULTS
The VAS score at postoperative 4 hours to 3 days among the groups showed a significant difference (P<0.05), but the VAS scores at postoperative 5 days to 1 month among the groups showed no significant difference (P>0.05). The frequency of pushing the self-controlled pain medication machine among the groups and the amount of clonac according to the needs of the patients among the groups showed that there were significant decreases at the operation day, the postoperative 1, 2 day and the 3 days (P<0.05).
CONCLUSION
PMDI has a significant effect on controlling the early postoperative pain after THA.

Keyword

Hip joint; Total hip arthroplasty; Pain; Periarticular drug injection

MeSH Terms

Amides
Analgesics
Anesthetics, Local
Arthroplasty
Arthroplasty, Replacement, Hip
Epinephrine
Head
Hip
Hip Joint
Humans
Morphine
Osteonecrosis
Pain, Postoperative
Tacrine
Amides
Analgesics
Anesthetics, Local
Epinephrine
Morphine
Tacrine

Figure

• 

  Fig. 1 The frequency of cloncac injection following needs of patients. The amount of clonac which was injected depending on the needs of patients in the group 1,2 and 3 at operation day, postoperative 1 day, 2 day, 3 day showed statistical difference (P=0.000,0.001,0.013, respectively) but no statistical difference at postoperative 5 day (P=0.775) * There was significant statistical difference among groups

• 

  Fig. 2 VAS score changes during postoperative 5 days. Immediate postoperative VAS scores in the group 1, 2 and 3, there was no significant statistical difference among groups(P=0.98). Postoperative 4 hour,8 hour,12 hour, 24 hour, 2 days and 3 days VAS scores were significant statistical difference among groups(P<0.05). VAS scores on postoperative 5 days, interestingly, there was no statistical (P=0.249). * There was significant statistical difference among groups.

• 

  Fig. 3 The Pearson's correlation coefficient for the total amount of Clonac which was injected depending on the needs of patients and the total frequency of self-pain-control push. The relationship with VAS score-the total Clonac injection and VAS score-the total frequency of self-pain-control push was analyzed by simple correlation analysis. * There was significant statistical difference (P<0.05)

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