Postoperative analgesia after total-hip arthroplasty: Comparison of intravenous patient-controlled analgesia with morphine and single injection of femoral nerve or psoas compartment block. a prospective, randomized, double-blind study

Philippe Biboulet, Didier Morau, Pierre Aubas, Sophie Bringuier-Branchereau, Xavier Capdevila
Regional Anesthesia and Pain Medicine 2004, 29 (2): 102-9

BACKGROUND: The authors compared the analgesic effects and quality of rehabilitation of three analgesic techniques after total-hip arthroplasty in a double-blind, randomized trial.

METHODS: Forty-five patients were assigned to 1 of 3 groups, patient-controlled analgesia with morphine (PCA), femoral nerve block (FNB), or psoas compartment block (PCB). At the end of the procedure performed under general anesthesia, nerve blocks using 2 mg/kg of 0.375% bupivacaine and 2 microg/kg of clonidine were performed in the FNB (n = 16) and PCB (n = 15) groups. In the recovery room, all 3 groups received initial intravenous morphine titration if their pain score was higher than 30 on a 100-mm visual analog scale (VAS), and then a PCA device was initiated. Morphine consumption was the primary end point to assess postoperative analgesia.

RESULTS: After extubation (H0), morphine titration was higher in the PCA group (P <.05). During the first 4 postoperative hours (H0 to H4), morphine consumption per hour and VAS pain score were lower in the PCB group (P <.05). After H4, there was no difference in morphine consumption and VAS among groups, either at rest or during mobilization. After H4, morphine consumption remained lower than 0.5 mg/h, and VAS remained lower than 30 mm in the 3 groups. In 4 patients of the PCB group, an epidural diffusion was noted. Hip mobility and length of stay in the rehabilitation center were not different among the groups.

CONCLUSIONS: PCA is an efficient and safe analgesia technique. FNB and PCB should not be used routinely after total-hip arthroplasty.

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