Thybo Kasper H, Schmidt Harald, Hägi-Pedersen Daniel
Department of Anaesthesiology, Næstved Hospital, Ringstedgade 61, 4700, Næstved, Denmark.
Department of Orthopaedic Surgery, Næstved Hospital, Ringstedgade 61, 4700, Næstved, Denmark.
BMC Anesthesiol. 2016 Mar 23;16:21. doi: 10.1186/s12871-016-0183-4.
Total hip arthroplasty (THA) is a common procedure associated with moderate postoperative pain. No nerve block without loss of motor function has been documented for THA. We hypothesised that an ultrasound-guided lateral femoral cutaneous nerve (LFCN) block added to a multimodal postoperative pain regimen would reduce postoperative pain after THA.
One hundred patients who had a THA by the posterior approach were evaluated in this randomised, placebo-controlled, blinded, parallel-group trial comparing an ultrasound-guided LFCN-block with either 8 ml of ropivacaine, 7.5 mg/ml, (Group Ropivacaine) or 8 ml of saline (Group Placebo) given postoperatively. Surgery was performed under spinal anaesthesia. The primary outcome was pain (measured on a Visual Analogue Scale (VAS)) 4 h post-blockade during 30° flexion of the hip. Secondary outcomes were pain at rest, pain during movement, oxycodone consumption (0-24 h), time to mobilisation, ability to mobilise, and length of stay. Patients, assessors and all staff involved with patient care were blinded to the intervention.
There was no difference in primary outcome between Group Ropivacaine and Group Placebo (VAS 27 mm vs. 31 mm, p = 0.41; difference -5 mm (95% CI: -15 mm - +5 mm). No differences in any of the secondary outcomes were observed. No adverse events, or harms, were observed during the trial.
Pain scores, opioid use, time to mobilisation, and length of stay were low in both Group Ropivacaine and Group Placebo. We found no added analgesic effect of a LFCN-block when combined with paracetamol and ibuprofen after THA by the posterior approach.
EudraCT: 2013-004501-12 (December 16th 2013).
全髋关节置换术（THA）是一种常见手术，术后疼痛程度中等。目前尚无关于THA且不影响运动功能的神经阻滞的记录。我们假设，在多模式术后疼痛治疗方案中加入超声引导下股外侧皮神经（LFCN）阻滞，可减轻THA术后疼痛。
在这项随机、安慰剂对照、双盲、平行组试验中，对100例采用后入路进行THA的患者进行了评估，比较超声引导下LFCN阻滞联合术后给予8 ml浓度为7.5 mg/ml的罗哌卡因（罗哌卡因组）或8 ml生理盐水（安慰剂组）的效果。手术在脊髓麻醉下进行。主要结局指标为阻滞后4小时、髋关节屈曲30°时的疼痛（采用视觉模拟评分法（VAS）测量）。次要结局指标包括静息时疼痛、活动时疼痛、羟考酮用量（0 - 24小时）、活动时间、活动能力及住院时间。患者、评估者及所有参与患者护理的工作人员均对干预措施不知情。
罗哌卡因组与安慰剂组的主要结局指标无差异（VAS评分分别为27 mm和31 mm，p = 0.41；差值为 - 5 mm（95% CI： - 15 mm - +5 mm））。次要结局指标方面未观察到差异。试验期间未观察到不良事件或损害。
罗哌卡因组和安慰剂组的疼痛评分、阿片类药物使用量、活动时间及住院时间均较低。我们发现，后入路THA术后，LFCN阻滞联合对乙酰氨基酚和布洛芬并未产生额外的镇痛效果。
EudraCT：2013 - 004501 - 12（2013年12月16日）
