From the *Department of Anaesthesia, AZ Groeninge, Kortrijk, Belgium; †Department of Anaesthesia, AZ Turnhout, Turnhout, Belgium; ‡Department Cardiovascular Sciences, KU Leuven, Department of Anesthesiology, UZ Leuven, Leuven, Belgium; §Clinical Laboratory, AZ Groeninge, Kortrijk, Belgium; and ∥Department of Public Health and Primary Care, KU Leuven Campus Kulak, Kortrijk, Belgium.
Reg Anesth Pain Med. 2017 May/Jun;42(3):327-333. doi: 10.1097/AAP.0000000000000543.
The role of a fascia iliaca compartment block (FICB) for postoperative analgesia after total hip arthroplasty (THA) remains questionable. High-dose local anesthetics and a proximal injection site may be essential for successful analgesia. High-dose local anesthetics may pose a risk for local anesthetic systemic toxicity. We hypothesized that a high-dose longitudinal supra-inguinal FICB is safe and decreases postoperative morphine consumption after anterior approach THA.
We conducted a prospective, double blind, randomized controlled trial. Patients scheduled for THA were randomized to group FICB (longitudinal supra-inguinal FICB with 40-mL ropivacaine 0.5%) or group C (control, no block). Standard hypothesis tests (t test or Mann-Whitney U test, χ test) were performed to analyze baseline characteristics and outcome parameters. The primary end point of the study was total morphine (mg) consumption at 24 hours postoperatively. Serial total and free ropivacaine serum levels were determined in 10 patients.
After obtaining ethical committee approval and written informed consent, 88 patients were included. Mean (SD) morphine consumption at 24 hours postoperatively was reduced in group FICB compared to group C: 10.25 (1.64) mg versus 19.0 (2.4) mg (P = 0.004). Using a mean dose of 2.6-mg/kg ropivacaine (range, 2-3.4 mg/kg), none of the patients had total or free ropivacaine levels above the maximum tolerated serum concentration.
We conclude that a high-dose longitudinal supra-inguinal FICB reduces postoperative morphine requirements after anterior approach THA.Clinical Trials Registry: EU Clinical Trials Register. www.clinicaltrialsregister.eu #2014-002122-12.
筋膜室隔阻滞（FICB）在全髋关节置换术后（THA）的术后镇痛中的作用仍存在争议。高剂量局部麻醉剂和靠近注射部位可能是成功镇痛的关键。高剂量局部麻醉剂可能会有全身麻醉毒性的风险。我们假设高剂量纵向骼腹股沟 FICB 是安全的，可以减少前路 THA 后术后吗啡的消耗。
我们进行了一项前瞻性、双盲、随机对照试验。计划接受 THA 的患者被随机分为 FICB 组（40ml 罗哌卡因 0.5%的纵向骼腹股沟 FICB）或 C 组（对照组，无阻滞）。采用标准假设检验（t 检验或 Mann-Whitney U 检验，χ2 检验）分析基线特征和结果参数。研究的主要终点是术后 24 小时内总吗啡（mg）消耗量。10 例患者连续测定总游离罗哌卡因血清水平。
在获得伦理委员会批准和书面知情同意后，纳入 88 例患者。与 C 组相比，FICB 组术后 24 小时吗啡消耗量降低：10.25（1.64）mg 比 19.0（2.4）mg（P = 0.004）。使用 2.6mg/kg 罗哌卡因的平均剂量（范围 2-3.4mg/kg），没有患者的总或游离罗哌卡因水平超过最大耐受血清浓度。
我们得出结论，高剂量纵向骼腹股沟 FICB 可减少前路 THA 后术后吗啡的需求。临床试验注册：欧盟临床试验注册中心。www.clinicaltrialsregister.eu #2014-002122-12。
