Eficácia da infiltração peri articular anestésica na analgesia pós-operatória de artroplastia total do quadril

Abstract

Rationale: Many patients suffer moderate to severe pain after Total Hip Arthroplasty (THA) procedure, leading to a prolonged hospitalization and consequent increase in postoperative complications. Intraoperative periarticular infiltration has been shown to be an effective technique for pain control, rehabilitation, reduced hospitalization time, risk of complications, and patient satisfaction in many studies. Primary objective: Evaluate the effectiveness of periarticular infiltration technique of the hip in the THA postoperative period. Methods: This was a randomized controlled clinical study carried out in patients undergoing the THA procedure at the Getúlio Vargas University Hospital. The technique of periarticular infiltration in tissues rich in nociceptors of the hip was performed after placement of the orthopedic implants, and subsequent evaluation of its effectiveness in comparison with the placebo group. Results: The patients in this study were between 44 and 82 years old (mean 64 years old). A reduction in opioid consumption was observed between 24h and 48h in the experimental group (p = 0.041). There was no significant difference between the groups regarding the use of opioids at the 24-hour time point (p=0.71) or at the 48-hour time point (p=0.16). A greater reduction in pain score was observed in the placebo group (mean -2.80) when compared to the experimental group (mean -1.35) with a p of 0.033. There was no difference between the groups in terms of pain index, at moments 24h (p=0.10) and 48h (p=1.0). The range of motion was similar between the groups, with no significant difference regarding the parameters flexion (p=0.81), adduction (p=0.84), abduction (p=0.61), internal rotation (p=0. 18) or external rotation (p=0.54). The period of onset of walking was also similar between the groups (mean 42.35 hours in the placebo group and 46.59 hours in the experimental group, p=0.68), as well as the length of stay (4.65 days in the placebo group vs. 5.0 days in the experimental, p=0.45) and the rate of complications (p=0.24). Conclusion: Intraoperative periarticular infiltration reduced the rate of opioid consumption when comparing the patient evolution between 24h and 48h. There are no benefits in terms of pain, mobility, length of stay or complications with this method.