Local infiltration anesthesia: does it really work?

Postoperative pain control after major surgeries such as total hip arthroplasty (THA) is so important because leads to an increased mobilization, decreased opioids consumption and hospital stay, all of which are the major concerns after THA surgery. Perioperative local infiltration anesthesia (LIA) is one of the recent techniques for achieving these purposes (1-3). LIA to the operation site is a simple way and have demonstrated great impacts on abdominal, thoracic, and plastic surgical setting. Actually, it is a widely used analgesic technique in recent years. In this technique, a solution including long-acting local anesthetic combined with opioids, non-steroidal anti-inflammatory drug (NSAID) or steroids are used (3,4). It can be done anytime related to surgery and preemptive usage of this modality is encouraged as well. In one study conducted by Ong et al. (5), it was indicated that preemptive LIA improved analgesic consumption and time to first pain relieving request, but it did not result in any decrease in postoperative pain scores. However, it has been shown that patients who received infiltration with local anesthetics experience lower pain scores as well as lower analgesic requirement. The effects of LIA could differ according to the type of surgical procedures, type and dosage of the used local anesthetic, adding adjuvants to local anesthetic, injection only into incision site or the whole wound, flap or joint and the use of intraarticular catheters for postoperative infusion. Shin et al. showed that preoperative bilateral superficial cervical plexus block and ropivacaine wound infiltration were more effective for reducing pain scores than ropivacaine wound infiltration alone in patients undergoing robotic thyroidectomy, which shows the efficacy of performing multiple injections for pain control (6).