Date Published: July 5, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Denise McCarthy, Gabriella Iohom.
Local infiltration analgesia (LIA) is an analgesic technique that has gained popularity since it was first brought to widespread attention by Kerr and Kohan in 2008. The technique involves the infiltration of a large volume dilute solution of a long-acting local anesthetic agent, often with adjuvants (e.g., epinephrine, ketorolac, an opioid), throughout the wound at the time of surgery. The analgesic effect duration can then be prolonged by the placement of a catheter to the surgical site for postoperative administration of further local anesthetic. The technique has been adopted for use for postoperative analgesia following a range of surgical procedures (orthopedic, general, gynecological, and breast surgeries). The primary objective of this paper was to determine, based on the current evidence, if LIA is superior when compared to no intervention, placebo, and alternative analgesic methods in patients following total hip arthroplasty, in terms of certain outcome measures. The outcomes considered were postoperative analgesia scores, joint function/rehabilitation, and length of hospital stay. Secondary objectives were to review available evidence and current knowledge regarding the pharmacokinetics of local anesthetic and adjuvant drugs when administered in this way and the occurrence of adverse events.
Ten studies (a total of 893 patients) were identified as pertinent and included for analysis—eight RCTs and two case series. It should be noted that four of these studies looked at a mixt population of patients undergoing hip resurfacing arthroplasty and total knee arthroplasty. The exclusions are outlined in Figure 1. The study characteristics of all articles included are detailed in Table 1.
In conclusion, the existing data regarding the use of local infiltration analgesia following total hip arthroplasty consists of the results from a relatively small number of small-moderate-sized clinical trials. The LIA technique has been shown to be an effective analgesic method. It has been proven to be superior to no infiltration, placebo saline infiltration and, in one study, epidural analgesia. It has not been shown to provide additional analgesic or outcome benefit in the setting of a comprehensive multimodal analgesic approach but can be regarded as an effective analgesic method following THA, and consideration should be given to its use by the surgeon and the anesthetist in the planning of the analgesic management strategy for this surgical procedure.