1 Orthopaedics, Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU2 Det Sundhedsvidenskabelige Fakultet, SDU3 Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU4 Orthopaedics, Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU
Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation Rune Bech*, Jens Lauritsen*+,Tine Dimon*, Ole Ovesen*, Claus Emmeluth, Søren Overgaard*. *:Dept. Ortopaedic Surgery, Odense University Hospital, +:Institute of Public Health-dept. biostatistics, Southern Denmark University. INTRODUCTION Reducing pain is an essential factor for early mobilisation after internal fixation of femoral neck fractures. Systemic opioids have side effects that might obstruct mobilisation and induce deliria and nausea. We hypothesized that intraarticular local anaesthetic results in pain relief without side effects and reduction in systemic opioid usage. We found no other studies describing this method in the literature. We present a pilot study on use of intraarticular local anesthesia in femoral neck fracture S72.0 patients. MATERIAL AND METHODS All 22 patients underwent osteosynthesis with 2 canulated hip screws and were prescribed regular paracetamol and supplementary opioid rescue analgesia as necessary. Pilot group: 11 patients received one peroperative (30 mL=100 mg) and 6 postoperative bolus installations (10 mL=100 mg) of open label Ropivacaine through an intraarticular catheter, which was removed after 48 hours. Control Group: 11 patients consecutively diagnosed in Sept. 2006, who received only standard pain treatment. The need for opioid rescue analgesia standardised to mg equivalent of oxycodon was compared between the two groups for the first two days after surgery. RESULTS The mean (CI) consumption on the 1st day after surgery was 12 (15-18) mg in the injection group and 28 (18-38) in the control group (p=0,007). On the 2nd day the consumption was 15 (6-23) and 26 (15-37) mg (p=0,073), respectively. Combined for the two days: 26.3 (14-39) versus 54 (34-74) (p=0.012). CONCLUSION This pilot-study suggests that intraarticular application of Ropivacaine may reduce opioid requirement after osteosynthesis of femoral neck fracture. However, this is an open pilot study with few patients. We find the results promising and have initiated a double-blinded prospective randomised trial according to the GCP guidelines.