硬膜外麻醉时可乐定和肾上腺素对麻醉效果和血清利多卡因浓度的影响

目的　研究硬膜外麻醉时 ,利多卡因溶液中加用可乐定或肾上腺素对血清利多卡因浓度和硬膜外麻醉效果的影响。方法　将 3 0例 ASA ～ 级下腹或下肢择期手术患者随机分为三组 :1组为利多卡因空白对照组 ,单纯 2 %利多卡因 6mg· kg- 1 硬膜外注射 ;2组为肾上腺素对照组 ,2 %利多卡因 6m g· kg- 1 加肾上腺素 5μg· ml- 1 硬膜外注射 ;3组为可乐定试验组 ,2 %利多卡因 6mg·kg- 1 加可乐定 5μg· m l- 1 硬膜外注射。测定感觉和运动阻滞的起效和恢复时间 ,并采集动脉血检测血清利多卡因浓度。结果　利多卡因溶液中加用可乐定 ( 1∶ 2 0万 ) ,可使硬膜外麻醉起效加快、作用间期延长 ,并能降低血清利多卡因浓度 ,其作用类似于利多卡因溶液加用同等浓度的肾上腺素。结论　可乐定作为一种血管活性因子可应用于硬膜外麻醉 ,以减少利多卡因的毒副作用     

Small dose of clonidine mixed with low-dose ropivacaine and fentanyl for epidural analgesia after total knee arthroplasty

Background. We studied whether a small dose of clonidine addedto a ropivacaine–fentanyl mixture improves epidural analgesiawithout provoking side effects typically related to larger amountsof epidural clonidine. Methods. In this randomized, double-blinded study, patients(     

Intrathecal ropivacaine for total hip arthroplasty: double-blind comparative study with isobaric 7.5 mg ml(-1) and 10 mg ml(-1) solutions

This study was designed to evaluate the efficacy and safetyof two concentrations of intrathecal ropivacaine, 7.5 and 10mg ml^–1, in patients undergoing total hip arthroplasty.One hundred and four patients, ASA I–III, were randomizedto receive an intrathecal injection of one of two concentrationsof isobaric ropivacaine. Group 1 (n=51) received 2.5 ml of 7.5mg ml^–1 ropivacaine (18.75 mg). Group 2 (n=53) received2.5 ml of 10 mg ml^–1 ropivacaine (25 mg). The onset andoffset of sensory block at dermatome level T10, maximum upperand lower spread of sensory block and the onset, intensity andduration of motor block were recorded, as were safety data.Onset of motor and sensory block was rapid with no significantdifferences between the two groups. The median time of onsetof sensory block at the T10 dermatome was 2 min (range 1–25min) in Group 1 and 2 min (range 1–21 min) in Group 2.The median duration of sensory block at the T10 dermatome was3.0 h (range 0.5–4.2 h) in Group 1 and 3.4 h (1.1–5.9h) in Group 2 (P=0.002). The median duration of complete motorblock was significantly prolonged (P<0.05) in Group 2 comparedwith Group 1 (1.9 vs 1.2 h, respectively). Anaesthetic conditionswere excellent in all but one patient. Intrathecal ropivacaine,in doses of 18.75 and 25 mg, was well tolerated and providedeffective anaesthesia for total hip arthroplasty. Br J Anaesth 2001; 87: 743–7     

连续腰丛神经阻滞联合夜间单次加强用于病人髋关节置换术后镇痛的效果

目的 评价连续腰丛神经阻滞联合夜间单次加强用于病人髋关节置换术后镇痛的效果.方法 择期拟行髋关节置换术病人60例,性别不限,年龄51 ～ 75岁,体重47 ～ 77 kg,身高150～181 cm,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将其随机分为术后病人自控静脉镇痛组(PCIA组)和连续腰丛神经阻滞联合夜间单次加强术后镇痛组(CLPB组),每组30例.所有病人行腰麻,手术结束前30 min,PCIA组病人上臂头静脉接病人自控静脉镇痛泵,药物配方:吗啡100mg+生理盐水稀释至100 ml,参数:首剂量0,持续量0,单次追加量2 mg,锁定时间5 min;CLPB组病人腰丛给予0.125％罗哌卡因30 ml后接镇痛泵,药物配方为0.125％盐酸罗哌卡因,持续量8 ml/h,单次追加量4 ml,锁定时间30 min,术后每晚8时追加0.25％罗哌卡因30 ml.记录术后6、12、18、24、30、36、42和48 h时病人静息及活动时VAS评分,观察恶心呕吐、瘙痒和尿潴留等不良反应的发生情况,随访总体满意情况,记录夜间由于疼痛导致睡眠中断次数和髋关节最大屈曲和外展活动度.结果 与PCIA组比较,CLPB组病人运动时VAS评分、术后恶心呕吐、瘙痒、尿潴留严重程度和夜间由于疼痛导致睡眠中断次数降低,病人总体满意度、髋关节最大屈曲和外展活动度升高(P＜0.05).结论 与术后病人自控静脉镇痛相比,连续腰丛神经阻滞联合夜间单次加强用于病人髋关节置换术后镇痛效果好,且并发症少.     

Effects of epidural clonidine and neostigmine following intrathecal labour analgesia: a randomised, double-blind, placebo-controlled trial

BackgroundThe limited duration of spinal labour analgesia combined with problems associated with maintenance of epidural analgesia, have prompted the search for combinations that could prolong spinal analgesia. A randomised, double-blind trial was carried out to test the hypotheses (a) that initial spinal labour analgesia is prolonged by administering clonidine and neostigmine epidurally whilst (b) the hourly local anaesthetic consumption is reduced.MethodsSeventy labouring patients received spinal analgesia with ropivacaine and sufentanil. Fifteen minutes after spinal injection, 10 mL of study solution was administered epidurally. The study solution was plain saline or neostigmine 500 μg combined with clonidine 75 μg. Outcome parameters were duration of spinal analgesia, local anaesthetic consumption and number of patients delivering without additional epidural analgesia.ResultsEpidural clonidine and neostigmine significantly prolonged initial analgesia: 144 (105–163) min vs. 95 (70–120) min in the placebo group and reduced hourly ropivacaine consumption: 7.5 (3.0–11.9) mg vs. 12.7 (9.6–16.9) mg. More patients in the experimental group delivered before the first request for additional analgesia (9 vs. 2).ConclusionEpidural administration of neostigmine 500 μg and clonidine 75 μg, following the intrathecal injection of ropivacaine and sufentanil, prolongs analgesia and reduces hourly ropivacaine consumption.     

Ultra-low dose combined spinal-epidural anesthesia with intrathecal bupivacaine 3.75 mg for cesarean delivery: a randomized controlled trial

BACKGROUND: We wished to investigate the feasibility of an ultra low-dose combined spinal-epidural technique in providing surgical anesthesia for uncomplicated cesarean deliveries in a randomized, double-blind controlled trial. METHOD: Forty-four normotensive, non-obese patients were randomized to receive either intrathecal hyperbaric bupivacaine 3.75 mg (low dose group, n=22) or 9 mg (conventional group, n=22), in addition to intrathecal fentanyl 25 microg, morphine 100 microg, and epidural 1.5% lidocaine 3 mL. Sensorimotor anesthesia and hemodynamic data were assessed at 2.5-min intervals for the first 15 min. RESULTS: The maximal sensory block achieved in the low-dose group was significantly lower than that in the conventional group (median T3, [range T2-T6] vs. T2 [C2-T6], P<0.001) with a longer time taken to reach maximal sensory block. The low-dose group had less motor block, faster sensory regression to T10 dermatome and faster motor recovery to Bromage 0 (all P<0.001). The block failed to reach T6 bilaterally within 10 min in one patient in the low-dose group and two in the conventional group, with no significant difference in the need for epidural supplementation before or after delivery of the baby. The low-dose group experienced less hypotension (14% vs. 73%, P<0.001) with less ephedrine usage (0.68 vs. 17.5 mg, P<0.001). There was no difference in operating conditions and other side effects (shivering, pruritus). CONCLUSION: We conclude that this technique results in a significantly lower incidence of maternal hypotension and has a role in high-risk parturients in whom maintenance of stable hemodynamics is imperative.     

Single-shot spinal anaesthesia, combined spinal-epidural and epidural volume extension for elective caesarean section: a randomized comparison

BackgroundSingle-shot spinal and combined spinal-epidural block, with or without epidural volume extension, can be used for caesarean section. There is no trial comparing their block characteristics and adverse effects under identical conditions.Methods60 ASA I or II parturients with gestational age 37 weeks or more, scheduled for elective caesarean section under regional anaesthesia, were included in the trial. Women were randomized to three groups: group SSS: single-shot spinal; group CSE: combined spinal-epidural; group EVE: epidural volume extension of a combined spinal-epidural. Intrathecal injection was identical in the three groups (0.5% hyperbaric bupivacaine 9 mg with fentanyl 10 μg) and was injected via a 25-gauge pencil-point spinal needle, either as a single-shot spinal or through the spinal needle of the needle-through-needle CSE set. In group EVE, 5 mL of normal saline was injected through the epidural catheter. All blocks were performed with the women sitting. Haemodynamic parameters and block characteristics were assessed.ResultsThe onset of maximum sensory and motor block was significantly faster in the SSS group than in the other two. Extent and duration of sensory and motor block and the incidence of adverse effects were similar in the three groups (P > 0.05).ConclusionsIntrathecal block is similar in extent and duration whether given as a single-shot spinal or a combined spinal-epidural with or without epidural volume extension when performed for elective caesarean section using hyperbaric bupivacaine in the sitting position.     

下肢手术患者罗哌卡因与布比卡因蛛网膜下腔阻滞效果的比较前瞻性、多中心、随机、双盲研究

目的 比较单侧下肢手术患者罗哌卡因和布比卡因蛛网膜下腔阻滞的效果.方法 本试验为前瞻性、多中心、随机、双盲的临床研究.拟行单侧下肢手术患者218例,ASA Ⅰ或Ⅱ级,年龄18～64岁,体重指数18～24 kg/m2,性别不限.随机分为2组,R组(n=110)蛛网膜下腔注射5 ms/ml罗哌卡因3.5 ml;B组(n=108)蛛网膜下腔注射5 mg/ml布比卡因2.5 ml.采用改良的Bromage评分法评估非术侧下肢的运动阻滞效果,记录起效时间和维持时间;采用针刺法评估感觉阻滞效果,记录起效时间和维持时间;评估术中麻醉质量与肌松效果;记录不良反应的发生情况.结果 与B组比较,R组运动阻滞起效时间延长,运动阻滞和感觉阻滞维持时间缩短(P＜0.05或0.01),感觉阻滞起效时间差异无统计学意义(P＞0.05);两组运动阻滞和感觉阻滞有效率差异无统计学意义(P＞0.05);两组麻醉质量和肌松效果均较好,麻醉质量比较差异无统计学意义(P＞0.05),R组肌松效果优于B组(P＜0.05);两组不良事件发生率均较低,且差异无统计学意义(P＞0.05).结论 下肢手术患者采用罗哌卡因蛛网膜下腔阻滞时,术中麻醉质量及肌松效果良好,且其运动阻滞维持时间较布比卡因短,有利于术后的恢复,其临床效果更具优越性.     

Combined spinal and epidural anesthesia for cesarean section in a parturient with moyamoya disease

We present the case of a parturient with moyamoya disease admitted to the hospital for elective cesarean section. Combined spinal and epidural technique was chosen because it allows better analgesia than epidural anesthesia and more hemodynamic stability than either general or spinal anesthesia. Ropivacaine was the local anesthetic of choice for the epidural portion because of the wide sensory-motor dissociation, thus preserving adequate respiration in the case of a high block.     

Caudal bupivacaine supplemented with caudal or intravenous clonidine in children undergoing hypospadias repair: a double-blind study

Background. Clonidine is used increasingly in paediatric anaestheticpractice to prolong the duration of action of caudal block witha local anaesthetic agent. Which route of administration ofclonidine is the most beneficial remains unknown. We comparedthe effects of caudal and i.v. clonidine on postoperative analgesiaproduced by caudal bupivacaine after hypospadias repair. Methods. Forty-six children (ASA I or II) aged 24–104months received standardized premedication with midazolam, ageneral anaesthetic and a caudal block with bupivacaine 0.25%,0.5 ml kg^–1. The children were randomized in a double-blindfashion to two groups: the i.v. group received clonidine 2 µg kg^–1i.v. and simultaneously the same volume of saline caudally.The caudal group received clonidine 2 µg kg^–1caudally and a similar volume of saline i.v. After surgery,all children received acetaminophen 20 mg kg^–1 rectallyor orally 6-hourly and were given a patient-controlled or nurse-controlledanalgesia (PCA/NCA) pump with i.v. morphine (bolus of 25 µg kg^–1and an 8-min lockout period with no background infusion). Monitoringof scores for pain, sedation, motor block, and postoperativenausea and vomiting was performed by nurses blinded to the studyallocations. Time to first activation of the PCA/NCA pump and0–24 h and 24–48 h morphine consumption were alsorecorded. Results. Forty-four children completed the study. Age, weightand duration of anaesthesia and surgery were similar in thetwo groups. The median (range) time to first activation of thePCA/NCA pump was similar in the two groups: 425 (150–1440)min in the i.v. group and 450 (130–1440) min in the caudalgroup. The number of children not requiring postoperative morphinewas four and seven respectively. Morphine consumption during0–24 h and 24–48 h was similar between groups. Conclusions. The analgesic effect of clonidine 2 µg kg^–1as an adjunct to caudal block with bupivacaine 0.25%, 0.5 ml kg^–1is similar whether administered i.v. or caudally. Br J Anaesth 2004; 92: 223–7     

Low-dose bupivacaine plus fentanyl for spinal anesthesia during ambulatory inguinal herniorrhaphy: a comparison between 6 mg and 7. 5 mg of bupivacaine

BACKGROUND: Inguinal herniorrhaphy is commonly performed as an outpatient procedure. Spinal anesthesia offers some advantages over general anesthesia in this setting. METHODS: Forty patients were randomly divided into two groups according to a double-blind protocol: Group L had spinal anesthesia with bupivacaine 6.0 mg and Group H with bupivacaine 7.5 mg; in both groups, fentanyl 25 micro g was added to the spinal anesthetic. The sensory block was measured by 'pin-prick' and the motor block was evaluated by a modified Bromage scale. RESULTS: No differences were seen in the spread, duration and regression of sensory block between the groups on the operated side. A greater number of patients required analgesics during the operation in Group L (6) compared with Group H (1) (P<0.05). The return of the modified Bromage scale to grade 0 was earlier in Group L than in Group H (P<0.05) but the time to mobilization and discharge was similar. Seven patients (17%) needed to be catheterized and two had the catheter retained overnight. Times to home discharge (median) were 350 and 445 min, respectively, in Groups L and H. Postoperatively and during the first week, visual analog pain scores, analgesic requirements and side-effects were similar between the groups. In Group H, 95% of the patients and in Group L 85% would have the same anesthetic again if operated upon for a similar procedure. CONCLUSIONS: Spinal anesthesia with bupivacaine 7.5 mg and fentanyl offers an alternative to general or local anesthesia for ambulatory inguinal herniorrhaphy. However, the long discharge times and risk for urinary retention restrict its routine use in all patients.     

The addition of clonidine 2 microg.kg-1 does not enhance the postoperative analgesia of a caudal block using 0.125% bupivacaine and epinephrine 1:200,000 in children: a prospective, double-blind, randomized study

BACKGROUND: In this prospective, randomized, double-blind study, we compared the efficacy of 0.125% bupivacaine and epinephrine 1:200,000 with and without clonidine 2 microg.kg-1 for 'single shot' pediatric caudal analgesia. METHODS: Thirty ASA I and II children, ages 2-8 years, undergoing outpatient surgical procedures below the umbilicus received 1 ml.kg-1 0.125% bupivacaine with fresh epinephrine 1:200,000 and clonidine 2 microg.kg-1 (group-C) or 1 ml.kg-1 0.125 % bupivacaine with epinephrine 1:200 000 (group-NC). All patients received a standardized general anesthetic (induction with 67% N2O in O2 and sevoflurane followed by isoflurane maintenance). Primary outcome measures were time to first rescue analgesic and number of patients requiring rescue analgesic at 4, 6, 8, 12, and 24 h after caudal placement. Secondary outcome measures included: extubation times, Objective Pain Scale (OPS) scores, sedation scores, time in postanesthesia care unit (PACU), discharge time, number of analgesic doses given in 24 h following caudal blockade, and adverse effects (vomiting, hypotension, and bradycardia). RESULTS: There were no differences in demographics, investigated parameters, or adverse effects between groups. CONCLUSIONS: We found that the addition of clonidine 2 microg.kg-1 to 0.125% bupivacaine with fresh epinephrine 1:200,000 for caudal analgesia did not significantly delay the time to first rescue analgesic or decrease the overall need for rescue analgesics in children 2-8 years undergoing surgical procedures below the umbilicus.     

Intra-operative paravertebral block for postoperative analgesia in thoracotomy patients: a randomized, double-blind, placebo-controlled study

Objective: Epidural analgesia is the gold standard for post-thoracotomy pain relief but is contraindicated in certain patients. An alternative is paravertebral block. We investigated whether ropivacaine, administered through a paravertebral catheter placed by the surgeon, reduced postoperative pain. Methods: In a randomized double-blind study, adult patients with a paravertebral catheter placed by the thoracic surgeon after thoracotomy were randomly assigned to receive through this catheter, either a 0.1 ml kg⁻¹ bolus of 0.5% ropivacaine, followed by a continuous infusion of 0.1 ml kg⁻¹ h⁻¹ for 48 h, or saline at the same scheme of administration. Patients also benefited from patient-controlled analgesia with intravenous morphine (bolus 1 mg, lockout time 7 min), paracetamol, and nefopam. The primary endpoint was pain intensity on a visual analog scale at rest and on coughing. Secondary endpoints were total morphine consumption and side effects during the first 48 postoperative hours. Surgeons, anesthesiologists, and all the nurses and caring staff involved in this study were blinded. Solutions of saline and ropivacaine were prepared identically by the central pharmacy, without any possible identification of the product. Results: Forty-seven patients with contraindications to epidural anesthesia were included. There were no significant differences between the groups receiving ropivacaine and saline in terms of pain severity at rest and on coughing, mean postoperative morphine consumption (45.7 mg for ropivacaine, 43.2 mg in controls), and incidence of morphine-related side effects (nausea and vomiting, urinary retention, pruritus, respiratory rate, and sedation). Conclusions: Paravertebral block using a catheter placed by the thoracic surgeon was ineffective on postoperative pain after thoracotomy and did not confirm the analgesic effect that has been observed after percutaneous catheter placement. A direct comparison of these two placement methods is required.     

Neuraxial anesthesia in a patient with anti-N-methyl-D-aspartate receptor encephalitis in pregnancy: management for cesarean delivery and oophorectomy

We describe the neuraxial anesthetic management of a 28-year-old primigravid patient with severe, treatment-refractory anti-N-methyl-D-aspartate receptor encephalitis undergoing cesarean delivery. The presence of an ovarian teratoma was suspected although not confirmed by imaging. The severity of symptoms, ineffective immunotherapy and the need for chemotherapy necessitated cesarean delivery and resection of a suspected teratoma at 28 weeks estimated gestational age. A combined spinal-epidural technique was used. Delivery was uneventful, and a right oophorectomy was performed for a visible lesion that was later confirmed to be a mature cystic teratoma.     

Spinal anaesthesia with articaine 5% vs bupivacaine 0.5% for day-case lower limb surgery: a double-blind randomized clinical trial

BACKGROUND: A local anaesthetic with fast onset and short reliable duration of anaesthesia may be preferable for out-patient lower limb surgery. Articaine is believed to act faster and to have a shorter duration of action than bupivacaine, but there are no conclusive data available. The purpose of this study was to compare articaine and bupivacaine for day-case lower limb surgery. METHODS: Eighty patients planned for day-case lower limb surgery enrolled in this study. Patients were randomized to receive hyperbaric articaine 80 mg or plain bupivacaine 15 mg intrathecally. Primary outcome variable was recovery time from motor block. Secondary outcomes were: onset of sensory and motor block, maximum spread of sensory block, time to micturition, discharge from the hospital, and complications. RESULTS: The groups were comparable for the medians and the range of the maximum blocks after 30 min. Median time to complete regression of motor block was 101 min (range 80-129) for articaine compared with 307 min (range 225-350) for bupivacaine (P<0.0005). First spontaneous micturition occurred after 257 min (210-293) in the articaine group and after 350 min (304-370) in the bupivacaine group (P<0.0005). In the articaine and bupivacaine groups, patients were discharged after 300 min (273-347) and 380 min (332-431), respectively (P<0.0005). There was no significant difference in the occurrence of complications between the groups. CONCLUSIONS: Spinal anaesthesia with 80 mg of hyperbaric articaine has a shorter duration than a spinal anaesthesia with 15 mg of plain bupivacaine in lower limb surgery of approximately 1 h duration.     

Epidural fentanyl markedly improves thoracic epidural analgesia in a low-dose infusion of bupivacaine, adrenaline and fentanyl. A randomized, double-blind crossover study with and without fentanyl

BACKGROUND: The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief, and side effects when removing fentanyl from an optimally titrated epidural infusion consisting of bupivacaine, fentanyl and adrenaline. METHODS: A prospective, randomized, double-blind, crossover study was carried out in 20 patients after major upper abdominal surgery requiring a large longitudinal incision. Patients with only mild pain when coughing during thoracic epidural infusion of about 10 ml per hour of bupivacaine 1 mg x ml(-1), fentanyl 2 microg x ml(-1), and adrenaline 2 microg x ml(-1) were included. On the 1st and 2nd postoperative days, each patient was given a double-blind epidural infusion, at the same rate, with or without fentanyl. The effects were observed for 6 h or until pain when coughing became unacceptable in spite of rescue analgesia. Rescue analgesia consisted of up to two patient-controlled epidural bolus injections (4 ml) per hour and intravenous morphine if necessary. RESULTS: Main outcome measures, i.e. pain intensity when coughing and at rest, increased (P<0.001) when fentanyl (19.2+/-5.2 microg x h(-1)) was omitted from the epidural infusion: after 6 h pain intensity when coughing had increased to unacceptable levels in spite of increased consumption of rescue bupivacaine and adrenaline (P<0.001). Within 15-20 min after restarting the triple epidural mixture with fentanyl, pain intensity was again reduced to mild pain when coughing. CONCLUSIONS: A low dose of epidural fentanyl (20 microg x h(-1)) markedly improved the pain-relieving effect of bupivacaine and adrenaline infused epidurally at a thoracic level after major upper abdominal surgery. This dose of fentanyl is much too small to relieve severe dynamic pain when given systemically. Therefore, this study indirectly supports the view that a low-dose thoracic epidural infusion of fentanyl has a spinal analgesic site of action.     

Epidural fentanyl, adrenaline and clonidine as adjuvants to local anaesthetics for surgical analgesia: meta-analyses of analgesia and side-effects

Background: The risk/benefit ratio of adding fentanyl, adrenaline and clonidine to epidural local anaesthetics for improving intraoperative analgesia is unclear. This meta-analysis was performed to clarify this issue.
Methods: Trials retrieved by search were considered if they were prospective, controlled, epidural analgesia (without combining general anaesthesia) was planned and occurrence of pain during surgery or side-effects were reported. Papers entered meta-analysis if they reached a predefined minimum quality score. Pooled odds ratios (OR) and confidence intervals (CI) were computed. P <0.05 was considered as significant.
Results: Eighteen trials were included in the analysis for fentanyl. Fentanyl decreased the likelihood of pain (OR=0.21, 95% CI=0.15–0.30, P <0.001) and increased the incidence of pruritus (OR=5.59, 95% CI=3.12–10.05, P <0.001) and sedation (OR= 1.88, 95% CI=1.19–2.98, P =0.003), compared to control (local anaesthetic without fentanyl). Fentanyl had no effect on respiratory depression, nausea, vomiting and Apgar score. One case of respiratory depression of a newborn was observed. Because of the very low number of trials selected, evaluation of adrenaline and clonidine was not feasible.
Conclusion: The analysis of current literature shows that the addition of fentanyl to local anaesthetics for intraoperative epidural analgesia is safe and advantageous. The reduction in the incidence of pain during surgery is quantitatively high and therefore clinically significant. Side-effects are mild. Randomized, controlled trials have to be performed in order to clarify the role of adrenaline and clonidine as epidural adjuvants for surgical analgesia.     

A new cocktail formula with diprospan of local infiltration analgesia in primary total hip arthroplasty: A prospective,randomized, controlled,observer‐blinded study

ObjectiveThis study aimed to observe the analgesic effect of the cocktail formulation with diprospan during total hip arthroplasty (THA).MethodsFrom September 2018 to April 2019, 120 patients undergoing primary unilateral THA were included in this prospective, randomized, observer‐blinded study. Patients were randomized into three groups, according to the different local infiltration analgesia (LIA) strategies: LIA with ropivacaine (the ropivacaine group, n = 40), LIA with a new cocktail containing ropivacaine, diprospan, and morphine (the cocktail group, n = 40), and the control group (n = 40). The primary outcomes included postoperative pain scores. The resting visual analogue scale (VAS) scores were measured at 2, 6, and 12 h after the surgery (a.m. and p.m.) on postoperative day (POD) 1, POD2, and the day of discharge. Movement VAS scores were assessed at 6 h, 12 h after the operation (a.m. and p.m.) on POD1, POD2, and the day of discharge. The secondary outcomes included opioid consumption, postoperative hospital stay, range of motion of the hip at discharge, patient satisfaction, and the results of the follow‐up.ResultsAfter the screening, 120 patients were randomized into three groups (40 patients in each group). All of the patients completed the trial. The resting VAS scores in the ropivacaine group and cocktail group at 2 h were lower than those in the control group (P < 0.001 and P < 0.001, respectively, F = 17.054), and the same trend was also postoperatively found at 6 h (p = 0.005 and P = 0.002, F = 6.212). Twelve hours after the operation, the pain score in the cocktail group was lower than that in the other two groups, but only the difference between the cocktail group and the control group was statistically significant (P = 0.018, F = 3.144). From the morning of the first postoperative day to the a.m. on POD 2, the VAS scores in the cocktail group were significantly lower than those in the ropivacaine group and the control group. Furthermore, the movement VAS scores in the ropivacaine group and the cocktail group were better than those in the control group at 6 and 12 h post‐operation (P < 0.05). The per capita opioid consumption in the cocktail group was less than that in the ropivacaine group and the control group within 24 h post‐operation. There were no significant differences in the comparison of additional indicators among the three groups.ConclusionThe new cocktail with diprospan had a better result and longer duration time for early postoperative pain control in primary THA via the posterolateral approach under general anesthesia, especially for treating resting pain.