Knee and hip replacements are two major surgeries, which can lead to severe postoperative pain. An effective pain relief is essential to ensure an expected recovery outcome. Local infiltration analgesia with bupivacaine (LIB) has been investigated and accepted globally. However, this has been a new method in Vietnam, and recently applied at Thong Nhat Hospital. The objective of this study was to evaluate the effectiveness of LIB in management of postoperative pain, compared with conventional regimen in patients undergoing knee or hip replacements. A retrospective cohort study was conducted using medical records of patients undergoing either knee or hip replacement. Patients with renal or hepatic failure, a history of drug addiction, or allergy to any study medications were excluded. Patients were randomly selected from two groups – conventional pain control (n = 40) and LIB pain control (n = 40). LIB regimen included spinal anesthesia during surgery, local injection of bupivacaine before wound closure, and analgesia such as opioid, NSAIDs and gabapentin after surgery as needed. Local injection of bupivacaine was not performed in the conventional group. There were no significant differences between two study groups with respect to baseline characteristics. Patients in LIB group had significantly lower rate of severe pain in the first day after surgery (p < 0.001), lower opioid consumption in the first three postoperative days (p < 0.05), lower rate of severe pain in the first day after surgery (p < 0.001), earlier ambulation (p = 0.004), lower length of hospital stay (p = 0.039), lower rate of sleep disturbance (p = 0.018), and lower rate of respiratory depression (p = 0.043), compared with those in conventional group. Our study suggests that LIB provided effective pain relief with less opioid consumption and an earlier functional recovery.
Keywords
Local infiltration analgesia; Bupivacaine; Knee replacement; Hip replacement; Postoperative pain; Opioid consumption