Comparative Efficacy of Periarticular Fentanyl versus Ketorolac for Postoperative Pain in Total Hip Arthroplasty: A Randomized Controlled Trial

Introduction: Local infiltration analgesia (LIA) has been reported as a viable option to tackle postoperative pain. Nonsteroidal anti-inflammatory drugs such as ketorolac and opioids such as fentanyl have shown promising results in the past. At the same time, there are other studies which has refuted any benefit of LIA in postoperative pain management. The presence of conflicting reports without any consensus on the best combination for LIA necessitates further research, and hence we conducted a triple-blinded randomized controlled trial to compare the efficacy of ketorolac and fentanyl in reducing post-operative pain when administered through LIA. Materials and Methods: This triple-blind randomized control trial was conducted on 90 consenting patients undergoing elective primary THA after obtaining institutional ethical approval. Patients were randomized into three groups (n = 30 each). Group A received LIA with Bupivacaine and fentanyl, Group B received bupivacaine and ketorolac, and Group C received normal saline. Postoperative pain was assessed using the visual analog scale (VAS) at 6, 12, 24, and 48 h postoperatively. Secondary outcomes included total analgesic consumption, time to ambulation, length of hospital stay, and incidence of postoperative nausea and vomiting. Results: Group A (Bupivacaine + Fentanyl) patients demonstrated significantly lower mean VAS pain scores at all time points compared to Group B (Bupivacaine + Ketorolac) and Group C (Normal Saline) (P < 0.05). The mean hospital stay was shortest in Group A (3.93 ± 0.74 days), with significant differences among all groups (P < 0.05). Total mean postoperative diclofenac consumption was lowest in Group A (387.5 ± 76.5 mg), and earlier ambulation was observed in Group A (2.5 ± 0.51 days) as compared to those in other groups (P < 0.05). The incidence of postoperative nausea and vomiting was also lowest in Group A (3.3%) compared to Groups B and C (P = 0.001). Conclusion: LIA with fentanyl provides superior postoperative analgesia compared to ketorolac in patients undergoing total hip arthroplasty, resulting in better pain control, reduced rescue analgesic use, earlier ambulation, shorter hospital stay, and lower incidence of nausea and vomiting. Keywords: Local infiltration analgesia, periarticular injection, fentanyl, bupivacaine, ketorolac, total hip arthroplasty.