Physical activity in the first postoperative week in 132 knee arthroplasty patients randomized to 3 different analgesic regimens.

BACKGROUND: The aim of this study was to investigate whether objectively recorded physical activity in the first week after surgery in total knee arthroplasty patients differed between patients allocated to 3 different analgesic regimens. METHODS: A total of 132 total knee arthroplasty patients wore activity monitors 24 hours a day from day 1 after surgery for 6 consecutive days. The time mobilized (stepping/standing) and the number of steps were recorded. This study was a sub-study of a randomized controlled study comparing tapentadol extended-release (ER), oxycodone controlled-release (CR), or a non-opioid placebo analgesic regimen. RESULTS: The placebo group spent significantly more time mobilized than the tapentadol ER and the oxycodone CR groups (P = .016 and .042, respectively), but no statistically significant differences were found between the groups in the number of steps taken. The activity levels of patients in all groups increased in the first week after surgery. CONCLUSION: Patients in the non-opioid placebo group spent more time mobilized the first week after surgery than those in the tapentadol ER and the oxycodone CR groups, while the number of steps was not different between the groups.

Perioperative local infiltration anesthesia with ropivacaine has no effect on postoperative pain after total hip arthroplasty.

BACKGROUND AND PURPOSE: The local infiltration analgesia (LIA) technique has been widely used to reduce opioid requirements and to improve postoperative mobilization following total hip arthroplasty (THA). However, the evidence for the efficacy of LIA in THA is not yet clear. We determined whether single-shot LIA in addition to a multimodal analgesic regimen would reduce acute postoperative pain and opioid requirements after THA. PATIENTS AND METHODS: 116 patients undergoing primary THA under spinal anesthesia were included in this randomized, double-blind, placebo-controlled trial. All patients received oral opioid-sparing multimodal analgesia: etoricoxib, acetaminophen, and glucocorticoid. The patients were randomized to receive either 150 mL ropivacaine (2 mg/mL) and 0.5 mL epinephrine (1 mg/mL) or 150 mL 0.9% saline. Rescue analgesic consisted of morphine and oxycodone as needed. The primary endpoint was pain during mobilization in the recovery unit. Secondary endpoints were pain during mobilization on the day after surgery and total postoperative opioid requirements on the first postoperative day. RESULTS: The levels of pain during mobilization-both in the recovery unit and on the day after surgery-and consumption of opioids on the first postoperative day were similar in the 2 groups. INTERPRETATION: LIA did not provide any extra analgesic effect after THA over and above that from the multimodal analgesic regimen used in this study.