Comparative Study of Different Concentrations of Ropivacaine in Combination with Hydromorphone: Effects on Rapid Rehabilitation after Total Hip Arthroplasty

Abstract

Background: Total hip arthroplasty (THA) is a common surgical procedure, performed on patients suffering from hip osteoarthrosis to ameliorate pain, and improve mobility and quality of life. Length of post-operative care and rehabilitation time before full recovery in the older population is a key concern in this surgical population. To improve these issues, we studied the effects of a novel combination of anesthetics on the anesthetic block effect, safety, and postoperative recovery time of old patients undergoing THA. We used increasing concentrations of ropivacaine (used for subarachnoid anesthesia) in combination with epidural hydromorphone. Methods: 90 old patients scheduled for THA were divided in three equal groups. A ropivacaine stock of 10 mg/mL was used for spinal anesthesia. Its final concentration for the three groups, A, B, and C was 0.33%, 0.4%, and 0.5%, respectively Hydromorphone (0.4 mg) was given through epidural catheter 30 min before the end of surgery. Results: Sensory block level at 5 min (T1) and 10 min (T2) in group C was higher than in group B followed by group A. Sensory block level was not different between the groups at 15 min (T3). Motor block score in group C was higher than in group B followed by group A. Incidences of hypotension, nausea, and vomiting were higher in group C compared to the other groups. Duration of sensory and motor blocks were longer in group C than in the other groups. The visual analog score at 12 h post-surgery in group A was higher than in group B followed by group C. Other rehabilitation parameters in group A were shorter than in group B followed by group C. Conclusions: Overall 0.4% ropivacaine hydrochloride 10 mg in combination with 0.4 mg hydromorphone led to quick rehabilitation with appreciable safety compared to the other combinations. Larger clinical studies are required to establish the efficacy of this novel anesthetic combination in THA.