Local Anesthetic Wound Infiltration after Osteosynthesis of Extracapsular Hip Fracture Does Not Reduce Pain or Opioid Requirements: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial in 49 Patients

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.

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

“…Although no infection was detected in this study, the authors emphasized strict use of aseptic techniques during catheter placement and care because of proximity to artificial implant material [234]. However, the analgesic benefit of WI has been questioned by a small recent RCT that showed no analgesic benefit with injecting ropivacaine vs. normal saline [235].…”

Pain management after hip fracture repair surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations

“…The control group received a saline infiltration and saline via the catheter. The study found no statistically significant effect in pain scores, at rest and during hip flexion, or postoperative opioid consumption between the intervention and the placebo group 56 .…”

“…One randomized controlled trial examined the effect of peri-operative local infiltration analgesia combined with the placement of a catheter on the anterior side of the greater trochanter in hip fracture patients surgically treated with a sliding hip screw 56 . The intervention group received perioperative LIA the greatest proportion of these patients, weighing logistical, financial and training issues in the balance may favour FICB in some circumstances, according to Newman et al…”

Intraoperatively local infiltration anesthesia in hemiarthroplasty patients reduces the needs of opioids: a randomized, double-blind, placebo-controlled trial with 96 patients in a fast-track hip fracture setting

“…The effect of LIA with ropivacaine in hip fracture patients operated on with internal fixation has been investigated, finding no reduction in postoperative pain score or opioid consumption ( 20 , 21 ). In these studies, LIA was given as a bolus dose intraoperatively, and thereafter postoperatively as repeated injections through a catheter placed intraoperatively for 48 hours.…”