Prise en charge de la douleur après prothèse totale de hanche

Patients undergoing total hip arthroplasty surgery are more than 120,000 per year in France. Women represent more than 60% and average age is around 69 years. At this moment, patients well informed, expect less pain and, even more, no pain after surgery. On one hand, moderate postoperative pain at rest increase with movement and quadriceps' reflex spasms. On the other hand, severe pain still occurred in 50% of patients, even at rest and for 70% of patients during mobilization. The best approach to ensure analgesic comfort and better functional rehabilitation is a multimodal analgesic approach. The addition of multiple sites of action can counteract nociceptive message. Goal of multimodal approach is to get additive or, even more, synergistic effect of associations and therefore by decreasing dose of each analgesic, we can decrease side effects. Regional analgesia performed preoperatively under ultrasound allows morphine-sparing or, even more, opioids abstention. Indeed, analgesia effect of regional anesthesia can be prolonged until 4 hours after surgery. By reducing morphine, we reduce morphine's hyperalgesic effect. The addition of anti-hyperalgesia drugs such as low-dose ketamine is now well admitted. The switch is provided by systematic oral non-opioid painkillers and if necessary by oral morphine according to pain intensity as rescue. Analgesia is one of the masterpieces of early postoperative rehabilitation. This will be supplemented by therapeutic education and will impact not only on postoperative pain but also on anxiety and thus functional recovery.