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Reduced Opioid Consumption and Improved Early Rehabilitation with Local and Intraarticular Cocktail Analgesic Injection in Total Hip Arthroplasty: A Randomized Controlled Clinical Trial


Yuli Wu, MD, Department of Orthopaedics, Changzheng Hospital, 415
Feng Yang Road, Shanghai 20003, China.
Tel: 0086-13311939190; Fax: 0086-021-63520020;


Objective.  Postoperative pain after total hip arthroplasty (THA) is not well tolerated. We assessed postoperative pain relief and the need for opioid use after using a cocktail of local and intraarticular analgesic injection (LIA) after THA.

Methods.  Eighty patients undergoing THA under spinal anesthesia were randomly assigned to receive either LIA or placebo. The LIA was composed of 5 mg morphine, 30 mg bupivacaine (15 mg/1.5 mL), 1 mL betamethasone, and 0.5 mL epinephrine (1:1,000) intraoperatively. We compared three outcomes total morphine consumption, visual analog scale (VAS) at rest and during activity, and hip flexion angle while standing.

Results.  When compared with placebo, opioid consumption was significantly reduced in the trial group, as well as VAS at rest and during mobilization. Earlier rehabilitation and better range of motion (ROM) were achieved in the trial group. There were no significant differences in side effects or postoperative wound healing between groups.

Conclusion.  In patients undergoing THA, LIA may reduce postoperative systemic opioid use and offer better pain control and earlier rehabilitation, without observable risks.