The following is a summary of “Continuous Intra-Incisional Bupivacaine for Postoperative Analgesia after Hip Nailing Surgery: A Randomized Clinical Trial,” published in the July 2024 issue of Pain by Farbood et al.

Researchers conducted a retrospective study examining the impact of continuous wound infiltration (CWI) with local anesthetic on postoperative pain control in patients undergoing hip nailing surgery for intertrochanteric fractures.

They included 48 patients scheduled for hip nailing surgery who were randomly assigned into 2 groups in which 1 group (n=24) received a postoperative bupivacaine infusion through a catheter placed inside the surgical wound. In contrast, the other group (n=24) did not. Pain intensity (NRS), morphine dosage requirements, and drug-related complications were assessed and compared within 24 hours of the intervention.

The result showed that pain intensity was significantly lower in the bupivacaine group during both the recovery room stay and the first 24 hours post-procedure in the ward (P<0.001). Patients in the control group consumed more morphine in the recovery room compared to the bupivacaine group (P<0.001) and required it earlier (60 (45–60) minutes vs. 360 (195–480) minutes, P<0.001). In the ward, all patients in the control group used the PCA morphine pump. In contrast, only 54% of the group receiving bupivacaine did, with the latter having significantly lower total morphine consumption (1 (0–2) mg vs. 10 (5–14) mg, P<0.001). None of the groups receiving bupivacaine required additional morphine, while 37.5% of the control group did (P=0.002). Overall, the control group had higher total morphine consumption in the first 24 hours compared to the bupivacaine group (10.5 (6–15.5) mg vs. 1 (0–2) mg, P<0.001).

Investigators concluded that CWI of bupivacaine enhanced early postoperative pain relief, reduced opioid consumption, minimized nausea and vomiting, and improved patient satisfaction.

Source: onlinelibrary.wiley.com/doi/10.1155/2024/2357709