Local infiltration analgesia with levobupivacaine compared with intrathecal morphine in total hip arthroplasty patients
Background Recently, local infiltration analgesia (LIA) has been promoted for pain control after total hip arthroplasty (THA). We hypothesized that LIA would offer equal analgesic efficacy but less adverse effects, e.g., nausea and vomiting, when compared with an established regimen [intrathecal mor...
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| Veröffentlicht in: | Acta anaesthesiologica Scandinavica 2012-07, Vol.56 (6), p.695-705 |
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| creator | RIKALAINEN-SALMI, R. FÖRSTER, J. G. MÄKELÄ, K. VIROLAINEN, P. LEINO, K. A. PITKÄNEN, M. T. NEUVONEN, P. J. KUUSNIEMI, K. S. |
| description | Background
Recently, local infiltration analgesia (LIA) has been promoted for pain control after total hip arthroplasty (THA). We hypothesized that LIA would offer equal analgesic efficacy but less adverse effects, e.g., nausea and vomiting, when compared with an established regimen [intrathecal morphine (it‐M)] after THA.
Methods
This randomized controlled trial comprised 60 patients undergoing THA under spinal anaesthesia. For LIA, the surgeon administered levobupivacaine, ketorolac and epinephrine at the surgical site intraoperatively. LIA patients received a LIA top‐up through a wound catheter on the morning of the 1st post‐operative day (POD). In group it‐M, 0.1 mg morphine was given together with the spinal anaesthetic. Study parameters included pain scores, vital parameters and side effects, e.g., post‐operative nausea and vomiting (PONV). Besides, levobupivacaine plasma concentrations were determined in 10 LIA patients.
Results
The median (25th/75th percentiles) rescue oxycodone demand differed significantly with LIA 15 (10/25) mg vs. 8.5 (1.5/15) mg with it‐M (P |
| doi_str_mv | 10.1111/j.1399-6576.2012.02667.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1919954769</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1919954769</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4987-b7c79a1e42ec5fa4fc0f2d0cff3ed9a96fd5e5a7291893b0cd5d8da2c72ccff73</originalsourceid><addsrcrecordid>eNqNkV-L1DAUxYso7uzqV5CCCL60JmnTNA8-DIvOCoMiKoIv4U6a2IxtU5N0Z-bbm9pxBJ_MS_6c37k33JMkKUY5juvVPscF51lFWZUThEmOSFWx_PggWV2Eh8kKIYQzihm5Sq6938drUXL-OLkipEQlKfEqOWythC41gzZdcBCMHVIYoPuuvIH0YEKbdure7qbR3IMEM6hU2n4Ep5pFNcNsa9VcpbdubGfEDGmwIb60ZkzBhdbZsQMfTukYW6gh-CfJIw2dV0_P-03y5e2bz7d32fbD5t3tepvJktcs2zHJOGBVEiWphlJLpEmDpNaFajjwSjdUUWCE45oXOyQb2tQNEMmIjBArbpKXS93R2Z-T8kH0xkvVdTAoO3mBOeaclqziEX3-D7q3k4uziBSrKKcVwUWk6oWSznrvlBajMz24k8BIzOGIvZgzEHMGYg5H_A5HHKP12bnBtOtVczH-SSMCL84A-DhP7WCQxv_lKK9IXdeRe71wB9Op039_QKzXn-ZT9GeL3_igjhc_uB8iqoyKr-834huiH6vNlghS_ALpiL0W</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1765956213</pqid></control><display><type>article</type><title>Local infiltration analgesia with levobupivacaine compared with intrathecal morphine in total hip arthroplasty patients</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>RIKALAINEN-SALMI, R. ; FÖRSTER, J. G. ; MÄKELÄ, K. ; VIROLAINEN, P. ; LEINO, K. A. ; PITKÄNEN, M. T. ; NEUVONEN, P. J. ; KUUSNIEMI, K. S.</creator><creatorcontrib>RIKALAINEN-SALMI, R. ; FÖRSTER, J. G. ; MÄKELÄ, K. ; VIROLAINEN, P. ; LEINO, K. A. ; PITKÄNEN, M. T. ; NEUVONEN, P. J. ; KUUSNIEMI, K. S.</creatorcontrib><description>Background
Recently, local infiltration analgesia (LIA) has been promoted for pain control after total hip arthroplasty (THA). We hypothesized that LIA would offer equal analgesic efficacy but less adverse effects, e.g., nausea and vomiting, when compared with an established regimen [intrathecal morphine (it‐M)] after THA.
Methods
This randomized controlled trial comprised 60 patients undergoing THA under spinal anaesthesia. For LIA, the surgeon administered levobupivacaine, ketorolac and epinephrine at the surgical site intraoperatively. LIA patients received a LIA top‐up through a wound catheter on the morning of the 1st post‐operative day (POD). In group it‐M, 0.1 mg morphine was given together with the spinal anaesthetic. Study parameters included pain scores, vital parameters and side effects, e.g., post‐operative nausea and vomiting (PONV). Besides, levobupivacaine plasma concentrations were determined in 10 LIA patients.
Results
The median (25th/75th percentiles) rescue oxycodone demand differed significantly with LIA 15 (10/25) mg vs. 8.5 (1.5/15) mg with it‐M (P < 0.006) during the day of surgery, but not anymore on 1st or 2nd POD. The LIA top‐up had no effect. However, both analgesic regimens resulted in comparable pain scores and patient satisfaction. PONV incidence and medication did not vary significantly. LIA offered certain advantages regarding early post‐operative mobilization. Maximum levobupivacaine plasma concentrations (229–580 ng/ml) remained under the toxic level.
Conclusions
While LIA might enable earlier mobilization after THA, it was not associated with less nausea as compared with it‐M. Less rescue oxycodone was given early after it‐M, but urinary retention was more common in that group.</description><identifier>ISSN: 0001-5172</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1111/j.1399-6576.2012.02667.x</identifier><identifier>PMID: 22404241</identifier><identifier>CODEN: AANEAB</identifier><language>eng</language><publisher>Oxford: Blackwell Publishing Ltd</publisher><subject><![CDATA[Adult ; Aged ; Aged, 80 and over ; Analgesics ; Analgesics, Opioid - administration & dosage ; Analgesics, Opioid - therapeutic use ; Anesthesia ; Anesthesia Recovery Period ; Anesthesia, Local - methods ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anesthetics, Local - administration & dosage ; Anesthetics, Local - blood ; Anesthetics, Local - therapeutic use ; Arthroplasty, Replacement, Hip - adverse effects ; Biological and medical sciences ; Bupivacaine - administration & dosage ; Bupivacaine - analogs & derivatives ; Bupivacaine - blood ; Bupivacaine - therapeutic use ; Early Ambulation ; Female ; Follow-Up Studies ; Humans ; Injections, Spinal ; Joint surgery ; Male ; Medical sciences ; Middle Aged ; Morphine - administration & dosage ; Morphine - therapeutic use ; Nausea ; Nerve Block ; Oxycodone - administration & dosage ; Oxycodone - therapeutic use ; Oxygen - blood ; Pain management ; Pain Management - methods ; Pain Measurement ; Pain, Postoperative - drug therapy ; Patient Discharge ; Patient Satisfaction ; Postoperative Nausea and Vomiting - epidemiology ; Single-Blind Method]]></subject><ispartof>Acta anaesthesiologica Scandinavica, 2012-07, Vol.56 (6), p.695-705</ispartof><rights>2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation</rights><rights>2015 INIST-CNRS</rights><rights>2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.</rights><rights>Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4987-b7c79a1e42ec5fa4fc0f2d0cff3ed9a96fd5e5a7291893b0cd5d8da2c72ccff73</citedby><cites>FETCH-LOGICAL-c4987-b7c79a1e42ec5fa4fc0f2d0cff3ed9a96fd5e5a7291893b0cd5d8da2c72ccff73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1399-6576.2012.02667.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1399-6576.2012.02667.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25962888$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22404241$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>RIKALAINEN-SALMI, R.</creatorcontrib><creatorcontrib>FÖRSTER, J. G.</creatorcontrib><creatorcontrib>MÄKELÄ, K.</creatorcontrib><creatorcontrib>VIROLAINEN, P.</creatorcontrib><creatorcontrib>LEINO, K. A.</creatorcontrib><creatorcontrib>PITKÄNEN, M. T.</creatorcontrib><creatorcontrib>NEUVONEN, P. J.</creatorcontrib><creatorcontrib>KUUSNIEMI, K. S.</creatorcontrib><title>Local infiltration analgesia with levobupivacaine compared with intrathecal morphine in total hip arthroplasty patients</title><title>Acta anaesthesiologica Scandinavica</title><addtitle>Acta Anaesthesiol Scand</addtitle><description>Background
Recently, local infiltration analgesia (LIA) has been promoted for pain control after total hip arthroplasty (THA). We hypothesized that LIA would offer equal analgesic efficacy but less adverse effects, e.g., nausea and vomiting, when compared with an established regimen [intrathecal morphine (it‐M)] after THA.
Methods
This randomized controlled trial comprised 60 patients undergoing THA under spinal anaesthesia. For LIA, the surgeon administered levobupivacaine, ketorolac and epinephrine at the surgical site intraoperatively. LIA patients received a LIA top‐up through a wound catheter on the morning of the 1st post‐operative day (POD). In group it‐M, 0.1 mg morphine was given together with the spinal anaesthetic. Study parameters included pain scores, vital parameters and side effects, e.g., post‐operative nausea and vomiting (PONV). Besides, levobupivacaine plasma concentrations were determined in 10 LIA patients.
Results
The median (25th/75th percentiles) rescue oxycodone demand differed significantly with LIA 15 (10/25) mg vs. 8.5 (1.5/15) mg with it‐M (P < 0.006) during the day of surgery, but not anymore on 1st or 2nd POD. The LIA top‐up had no effect. However, both analgesic regimens resulted in comparable pain scores and patient satisfaction. PONV incidence and medication did not vary significantly. LIA offered certain advantages regarding early post‐operative mobilization. Maximum levobupivacaine plasma concentrations (229–580 ng/ml) remained under the toxic level.
Conclusions
While LIA might enable earlier mobilization after THA, it was not associated with less nausea as compared with it‐M. Less rescue oxycodone was given early after it‐M, but urinary retention was more common in that group.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analgesics</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Anesthesia</subject><subject>Anesthesia Recovery Period</subject><subject>Anesthesia, Local - methods</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anesthetics, Local - administration & dosage</subject><subject>Anesthetics, Local - blood</subject><subject>Anesthetics, Local - therapeutic use</subject><subject>Arthroplasty, Replacement, Hip - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Bupivacaine - administration & dosage</subject><subject>Bupivacaine - analogs & derivatives</subject><subject>Bupivacaine - blood</subject><subject>Bupivacaine - therapeutic use</subject><subject>Early Ambulation</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Injections, Spinal</subject><subject>Joint surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Morphine - administration & dosage</subject><subject>Morphine - therapeutic use</subject><subject>Nausea</subject><subject>Nerve Block</subject><subject>Oxycodone - administration & dosage</subject><subject>Oxycodone - therapeutic use</subject><subject>Oxygen - blood</subject><subject>Pain management</subject><subject>Pain Management - methods</subject><subject>Pain Measurement</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Patient Discharge</subject><subject>Patient Satisfaction</subject><subject>Postoperative Nausea and Vomiting - epidemiology</subject><subject>Single-Blind Method</subject><issn>0001-5172</issn><issn>1399-6576</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkV-L1DAUxYso7uzqV5CCCL60JmnTNA8-DIvOCoMiKoIv4U6a2IxtU5N0Z-bbm9pxBJ_MS_6c37k33JMkKUY5juvVPscF51lFWZUThEmOSFWx_PggWV2Eh8kKIYQzihm5Sq6938drUXL-OLkipEQlKfEqOWythC41gzZdcBCMHVIYoPuuvIH0YEKbdure7qbR3IMEM6hU2n4Ep5pFNcNsa9VcpbdubGfEDGmwIb60ZkzBhdbZsQMfTukYW6gh-CfJIw2dV0_P-03y5e2bz7d32fbD5t3tepvJktcs2zHJOGBVEiWphlJLpEmDpNaFajjwSjdUUWCE45oXOyQb2tQNEMmIjBArbpKXS93R2Z-T8kH0xkvVdTAoO3mBOeaclqziEX3-D7q3k4uziBSrKKcVwUWk6oWSznrvlBajMz24k8BIzOGIvZgzEHMGYg5H_A5HHKP12bnBtOtVczH-SSMCL84A-DhP7WCQxv_lKK9IXdeRe71wB9Op039_QKzXn-ZT9GeL3_igjhc_uB8iqoyKr-834huiH6vNlghS_ALpiL0W</recordid><startdate>201207</startdate><enddate>201207</enddate><creator>RIKALAINEN-SALMI, R.</creator><creator>FÖRSTER, J. G.</creator><creator>MÄKELÄ, K.</creator><creator>VIROLAINEN, P.</creator><creator>LEINO, K. A.</creator><creator>PITKÄNEN, M. T.</creator><creator>NEUVONEN, P. J.</creator><creator>KUUSNIEMI, K. S.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>7U7</scope><scope>C1K</scope></search><sort><creationdate>201207</creationdate><title>Local infiltration analgesia with levobupivacaine compared with intrathecal morphine in total hip arthroplasty patients</title><author>RIKALAINEN-SALMI, R. ; FÖRSTER, J. G. ; MÄKELÄ, K. ; VIROLAINEN, P. ; LEINO, K. A. ; PITKÄNEN, M. T. ; NEUVONEN, P. J. ; KUUSNIEMI, K. S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4987-b7c79a1e42ec5fa4fc0f2d0cff3ed9a96fd5e5a7291893b0cd5d8da2c72ccff73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analgesics</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Anesthesia</topic><topic>Anesthesia Recovery Period</topic><topic>Anesthesia, Local - methods</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anesthetics, Local - administration & dosage</topic><topic>Anesthetics, Local - blood</topic><topic>Anesthetics, Local - therapeutic use</topic><topic>Arthroplasty, Replacement, Hip - adverse effects</topic><topic>Biological and medical sciences</topic><topic>Bupivacaine - administration & dosage</topic><topic>Bupivacaine - analogs & derivatives</topic><topic>Bupivacaine - blood</topic><topic>Bupivacaine - therapeutic use</topic><topic>Early Ambulation</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Injections, Spinal</topic><topic>Joint surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Morphine - administration & dosage</topic><topic>Morphine - therapeutic use</topic><topic>Nausea</topic><topic>Nerve Block</topic><topic>Oxycodone - administration & dosage</topic><topic>Oxycodone - therapeutic use</topic><topic>Oxygen - blood</topic><topic>Pain management</topic><topic>Pain Management - methods</topic><topic>Pain Measurement</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Patient Discharge</topic><topic>Patient Satisfaction</topic><topic>Postoperative Nausea and Vomiting - epidemiology</topic><topic>Single-Blind Method</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>RIKALAINEN-SALMI, R.</creatorcontrib><creatorcontrib>FÖRSTER, J. G.</creatorcontrib><creatorcontrib>MÄKELÄ, K.</creatorcontrib><creatorcontrib>VIROLAINEN, P.</creatorcontrib><creatorcontrib>LEINO, K. A.</creatorcontrib><creatorcontrib>PITKÄNEN, M. T.</creatorcontrib><creatorcontrib>NEUVONEN, P. J.</creatorcontrib><creatorcontrib>KUUSNIEMI, K. S.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>RIKALAINEN-SALMI, R.</au><au>FÖRSTER, J. G.</au><au>MÄKELÄ, K.</au><au>VIROLAINEN, P.</au><au>LEINO, K. A.</au><au>PITKÄNEN, M. T.</au><au>NEUVONEN, P. J.</au><au>KUUSNIEMI, K. S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Local infiltration analgesia with levobupivacaine compared with intrathecal morphine in total hip arthroplasty patients</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>2012-07</date><risdate>2012</risdate><volume>56</volume><issue>6</issue><spage>695</spage><epage>705</epage><pages>695-705</pages><issn>0001-5172</issn><eissn>1399-6576</eissn><coden>AANEAB</coden><abstract>Background
Recently, local infiltration analgesia (LIA) has been promoted for pain control after total hip arthroplasty (THA). We hypothesized that LIA would offer equal analgesic efficacy but less adverse effects, e.g., nausea and vomiting, when compared with an established regimen [intrathecal morphine (it‐M)] after THA.
Methods
This randomized controlled trial comprised 60 patients undergoing THA under spinal anaesthesia. For LIA, the surgeon administered levobupivacaine, ketorolac and epinephrine at the surgical site intraoperatively. LIA patients received a LIA top‐up through a wound catheter on the morning of the 1st post‐operative day (POD). In group it‐M, 0.1 mg morphine was given together with the spinal anaesthetic. Study parameters included pain scores, vital parameters and side effects, e.g., post‐operative nausea and vomiting (PONV). Besides, levobupivacaine plasma concentrations were determined in 10 LIA patients.
Results
The median (25th/75th percentiles) rescue oxycodone demand differed significantly with LIA 15 (10/25) mg vs. 8.5 (1.5/15) mg with it‐M (P < 0.006) during the day of surgery, but not anymore on 1st or 2nd POD. The LIA top‐up had no effect. However, both analgesic regimens resulted in comparable pain scores and patient satisfaction. PONV incidence and medication did not vary significantly. LIA offered certain advantages regarding early post‐operative mobilization. Maximum levobupivacaine plasma concentrations (229–580 ng/ml) remained under the toxic level.
Conclusions
While LIA might enable earlier mobilization after THA, it was not associated with less nausea as compared with it‐M. Less rescue oxycodone was given early after it‐M, but urinary retention was more common in that group.</abstract><cop>Oxford</cop><pub>Blackwell Publishing Ltd</pub><pmid>22404241</pmid><doi>10.1111/j.1399-6576.2012.02667.x</doi><tpages>11</tpages></addata></record> |
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| ispartof | Acta anaesthesiologica Scandinavica, 2012-07, Vol.56 (6), p.695-705 |
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| subjects | Adult Aged Aged, 80 and over Analgesics Analgesics, Opioid - administration & dosage Analgesics, Opioid - therapeutic use Anesthesia Anesthesia Recovery Period Anesthesia, Local - methods Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthetics, Local - administration & dosage Anesthetics, Local - blood Anesthetics, Local - therapeutic use Arthroplasty, Replacement, Hip - adverse effects Biological and medical sciences Bupivacaine - administration & dosage Bupivacaine - analogs & derivatives Bupivacaine - blood Bupivacaine - therapeutic use Early Ambulation Female Follow-Up Studies Humans Injections, Spinal Joint surgery Male Medical sciences Middle Aged Morphine - administration & dosage Morphine - therapeutic use Nausea Nerve Block Oxycodone - administration & dosage Oxycodone - therapeutic use Oxygen - blood Pain management Pain Management - methods Pain Measurement Pain, Postoperative - drug therapy Patient Discharge Patient Satisfaction Postoperative Nausea and Vomiting - epidemiology Single-Blind Method |
| title | Local infiltration analgesia with levobupivacaine compared with intrathecal morphine in total hip arthroplasty patients |
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