Infiltration Technique Descriptions
6
THA Direct Lateral Approach
Injection solution includes bupivacaine liposomal injectable suspension (EXPAREL)
20 mL and 0.25% bupivacaine with epinephrine 30 mL. Normal saline 10-20 mL may
be added if extra volume is needed.
Infiltration Technique
Local
Analgesic
Volume
Step 1: Deep Injection
Before placing the acetabular shell, inject 20 mL into the anterior capsule
and periosteum, the inferior capsule, the superior capsule and periosteum,
the psoas tendon sheath, the superior deep layer of abductors, and the
anterior femoral periosteum.
20 mL
Step 2: Anterior Injection
Inject 10 mL into the vastus lateralis, gluteus medius and minimus. 10 mL
Step 3: Superficial Injection
Aer insertion of the femoral prosthesis, inject the remaining 20 mL into
the tensor layer, ilio-tibial band, gluteus maximus, the subcutaneous layer
and skin.
20 mL
Note: For revisions:
• Extend the deep injections, prior to stem placement but following
placement of the acetabular cup:
▶ more broadly superiorly in the region of the peri-acetabular
periosteum
▶ further along the femoral periosteum
▶ into the vastus lateralis & deep quadriceps muscles
• Extend the mid-layer injections, being careful to avoid the sciatic nerve:
▶ into the gluteus maximus
▶ into the interosseus membrane
• Extend the superficial injections:
▶ more broadly along the deep tissues & subcutaneous layers