Background: We compared the efficacy and safety of a modified cocktail for postoperative analgesia and early functional rehabilitation in patients undergoing total hip arthroplasty (THA).
Methods: A prospective, double-blind randomized controlled trial was conducted with 200 patients who underwent unilateral primary THA at our hospital. Magnesium sulfate and sodium bicarbonate were added to a traditional cocktail of ropivacaine, epinephrine, and dexamethasone. Primary outcome measures were visual analogue scale (VAS) pain scores at various intervals after surgery; morphine consumption for rescue analgesia after surgery; and time to first rescue analgesia. Secondary outcomes were hip function after surgery, daily walking distance, and quadriceps muscle strength. The third index was the incidence of postoperative adverse reactions.
Results: Morphine consumption was significantly lower in the modified cocktail group than in the control group in the first 24 hours after surgery (6.2 ± 6.0 versus 14.2 ± 6.4 mg, P < 0.001), as was total morphine consumption (10.0 ± 8.6 versus 19.2 ± 10.1 mg, P < 0.001). The duration of the first rescue analgesia was significantly prolonged (23.7 ± 10.3 versus 11.9 ± 5.8 mg, P < 0.001). Morphine consumption was also significantly reduced in the magnesium sulfate and sodium bicarbonate groups over a 24-hour period compared with that in the control group (9.4 ± 6.5 versus 14.2 ± 6.4 mg, P < 0.001, 9.6 ± 6.4 versus 14.2 ± 6.4 mg, P < 0.001). The modified cocktail group had significantly lower resting VAS pain scores than the control group at 6, 12, and 24 hours after surgery (P = 0.036, P = 0.010, and P = 0.017, respectively). The VAS pain scores during movement at 6 and 12 hours after surgery were also significantly lower than those in the control group (P = 0.045, P < 0.001, respectively). The modified cocktail, magnesium sulfate, and sodium bicarbonate groups showed better hip range of motion (P < 0.001, P = 0.013, P = 0.046, respectively) and longer walking distance (P < 0.001, P = 0.014, P = 0.019, respectively) on the first postoperative day, and levels of inflammatory markers were significantly reduced. The incidence of postoperative adverse reactions was similar among the four groups.
Conclusion: The modified cocktail with a new adjuvant can prolong the duration of postoperative analgesia, reduce the dosage of rescue analgesics, and accelerate early postoperative functional recovery in patients undergoing THA.
Keywords: Cocktail; Pain; Periarticular infiltration analgesia; Total hip arthroplasty.
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