Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, Texas, USA
Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, Texas, USA.
Reg Anesth Pain Med. 2019 Feb;44(2):206-211. doi: 10.1136/rapm-2018-000016.
Fascia iliaca compartment block (FICB) has been shown to provide excellent pain relief in patients undergoing total hip arthroplasty (THA). However, the analgesic efficacy of FICB, in comparison with periarticular infiltration (PAI) for THA, has not been evaluated. This randomized, controlled, observer-blinded study was designed to compare suprainguinal FICB (SFICB) with PAI in patients undergoing THA via posterior approach.
After institutional review board approval, 60 consenting patients scheduled for elective THA were randomized to one of two groups: ultrasound-guided SFICB block or PAI. The local anesthetic solution for both the groups included 60 mL ropivacaine 300 mg and epinephrine 150 µg. The remaining aspects of perioperative care, including general anesthetic and non-opioid multimodal analgesic techniques, were standardized. An investigator blinded to group allocation documented pain scores at rest and with movement and supplemental opioid requirements at various time points. Patients were evaluated for sensory changes and quadriceps weakness in the operated extremity.
There were no differences between the groups with respect to demographics, intraoperative opioid use, duration of surgery, recovery room stay, nausea scores, need for rescue antiemetics, time to ambulation and time to discharge readiness as well as 48 hours postoperative opioid requirements. The pain scores at rest and with movement also were similar at all time points. Significantly more patients in the SFICB group experienced muscle weakness at 6 hours after surgery.
Under the circumstances of our study, in patients undergoing THA, SFICB provided the similar pain relief compared with PAI, but was associated with muscle weakness at 6 hours postoperatively.
NCT02658240.
股外侧肌间隙阻滞（FICB）已被证实可有效缓解全髋关节置换术（THA）患者的疼痛。然而，与关节周围浸润（PAI）相比，FICB 对 THA 的镇痛效果尚未得到评估。本随机、对照、观察者盲法研究旨在比较经后路行 THA 时，超髂腹股沟 FICB（SFICB）与 PAI 的效果。
在机构审查委员会批准后，将 60 名择期行 THA 的患者同意书随机分为两组：超声引导下 SFICB 阻滞或 PAI。两组的局部麻醉溶液均包括 60 mL 罗哌卡因 300 mg 和肾上腺素 150 µg。围手术期护理的其他方面，包括全身麻醉和非阿片类多模式镇痛技术，均标准化。一位对分组不知情的研究者记录了各个时间点的静息和运动时疼痛评分以及补充阿片类药物的需求。评估患者手术肢体的感觉变化和股四头肌无力。
两组患者在人口统计学、术中阿片类药物使用、手术持续时间、恢复室停留时间、恶心评分、需要使用止吐药、下床活动时间和出院准备时间以及术后 48 小时阿片类药物需求方面无差异。在所有时间点，静息和运动时的疼痛评分也相似。SFICB 组在术后 6 小时有更多的患者出现肌肉无力。
在我们的研究中，在接受 THA 的患者中，SFICB 与 PAI 相比提供了相似的疼痛缓解，但与术后 6 小时的肌肉无力有关。
NCT02658240。
