Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Acta Anaesthesiol Scand. 2011 Aug;55(7):778-84. doi: 10.1111/j.1399-6576.2011.02429.x. Epub 2011 Apr 4.

Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice.

Author information

  • 1Section for Surgical Pathophysiology, Rigshospitalet Copenhagen University, Copenhagen, Denmark. henrik.kehlet@rh.dk

Abstract

Relief of acute pain after hip and knee replacement represents a major therapeutic challenge as post-operative pain hinders early mobilisation and rehabilitation with subsequent consequences on mobility, duration of hospitalisation and overall recovery. In recent years, there has been increased interest in high-volume local wound infiltration/infusion techniques in these operations with a combined administration of local anaesthetics, NSAIDs and epinephrine. This review provides an update of the current knowledge of the efficacy of the high-volume wound infiltration technique based on randomised trials. It is concluded that a predominant part of the data have had an insufficient design by not being placebo-controlled or with comparable systemic analgesia provided in the investigated groups. It is concluded that there is little evidence to support the use of the technique in hip replacement either intraoperatively or with a post-operative wound infusion catheter technique, provided that multimodal, oral non-opioid analgesia is given. In knee replacement, the data support the intraoperative use of the local infiltration technique but not the post-operative use of wound catheter administration. In knee replacement, a compression bandage prolongs the analgesic effect. There are limited data to support the use of NSAIDs or epinephrine in the solution and the data on post-operative hospitalisation and recovery are conflicting. Thus, shorter lengths of stay have been achieved by oral multimodal, non-opioid analgesia together with organisational optimisation of care according to the fast-track methodology.

© 2011 The Authors. Acta Anaesthesiologica Scandinavica © 2011 The Acta Anaesthesiologica Scandinavica Foundation.

Comment in

PMID:
21463261
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Blackwell Publishing
    Loading ...
    Write to the Help Desk