Efficacy of Postoperative Pain Control Between Transarticular VS Periartiucular Multimodal Drug Infiltration in Total Hip Arthroplasty: Double-blinded Randomized Control Trial

Efficacy of Postoperative Pain Control Between Transarticular VS Periartiucular Multimodal Drug Infiltration in Total Hip Arthroplasty: Double-blinded Randomized Control Trial

This research aim to improve postoperative outcome in total hip arthroplasty(THA) by using local mixture infiltration as bupivacaine + NSAID + epinephrine + tranxemic acid. In the present time these mixture components has shown to improve THA outcome by aspect of postoperative pain control, postoperative opioid consumption, postoperative bleeding, LOS and postoperative rehabilitation without increasing complication but the accuracy of infiltration technique which gives the best outcome has not been yet discovered.Recently study by Hashimoto et al has risen that these technique can be administrated by both periarticular and intra-articular approach.By considering the complexity of human anatomy around the hip tissue we assume that the intra-articular(transarticular) may given equivalence (may be better) outcome with lowering procedural related complication comparing to periarticular infiltration approach.

Inclusion Criteria:

• patient who would go on cemented and cementless THA
• age 45-60 years of age
• voluntary decision exclusion criteria
• bilateral THA
• revision surgery
• history of pelvic and hip surgery previously
• allergy to medication in protocol
• CKD stage 4-5, chronic liver disease with Child Pugh B or C
• pregnancy
• history of hip injection
• U/D
• hypercoagulable state
• abnormal laboratory coagulation study as INR > 1.4 or aPTT > 1.4
• abnormal platelet function
• thrombocytopenia
• PE , DVT, ischemic stroke, CAD/ischemic heart disease
• use of anticoagulant or hormonal usage
• anesthesia by general anesthesia or additional nerve block
• can not understand PCA usage
• use postopertive wound drainage