Pain after hip arthroplasty: personal reflections of an anesthesiologist

Hip arthroplasty is one of the most common surgeries performed globally, with more than 500,000 operations int the US and 3.1 million in Europe performed annually. In 2019, 147,061 hip and knee arthroplasty surgeries were performed in Russia. Hip arthroplasty involves a moderate degree of trauma and is performed under neuraxial anesthesia. However, severe pain in the early postoperative period has been reported postarthroplasty. I had a hip arthroplasty performed under spinal anesthesia with «heavy» bupivacaine (12.5 mg). The operation lasted for 1 hour and motor block regressed 5 hours postsurgery. One hour after the end of the motor block, I experienced mild pain (VAS score 2). The pain intensified to VAS score 7 after 2 hours. Intramuscular injection of 10 mg morphine did not relieve the pain. One hour after morphine administration, 30 mg of ketorolac was administered intramuscularly. After 60 minutes, pain intensity decreased to VAS score 3. Morphine and ketorolac were then administered simultaneously at night and achieved pain levels of VAS score 1–2. The following day, morphine and ketorolac were administered in the morning and evening, resulting in complete pain resolution. No more analgesics were used. In my opinion, the combination of morphine and ketorolac on the day of surgery and twice the next day allows complete elimination of pain after hip arthroplasty.