Combination of post-fascia iliaca compartment block and dexmedetomidine in pain and inflammation control after total hip arthroplasty for elder patients: a randomized control study

Xiaofen Liu,Rui Li,Xianwen Hu,Ye Zhang

doi:10.1186/s13018-020-1562-6

Abstract

ObjectiveThis study aims to investigate the efficiency of fascia iliaca compartment block (FICB) combined with dexmedetomidine (DEX) in postoperative and inflammation management for elder patients after total hip arthroplasty.MethodsThe present randomized controlled study included a total of 119 elder patients who received total hip arthroplasty in our hospital from March 2016 to December 2018. These patients were divided into three groups: control group, patients received routine general anesthesia; FICB group, patients received additional FICB after surgery; and combined group, patients received both pre-treatment of DEX and post-treatment of fascia iliaca compartment block. The serum levels of interleukin (IL)-1β, IL-6, and C-reactive protein (CRP) were measured by ELISA. The visual analog scale (VAS) score was measured at 12, 24, 48, and 72 h after surgery, and the patient-controlled intravenous analgesia (PCIA) pressing time within 48 h after surgery was also recorded. The Pittsburgh sleep quality index (PSQI) was used to measure the sleep quality before and at 1 month after surgery.ResultsThe VAS scores were significantly lower in patients in the combined group, when compared with the other two groups, at 12, 24, 48, and 72 h after surgery. In addition, the VAS scores at all time points were significantly lower in the FICB group than the control group. The PCIA pressing times were also remarkably lower in the combined group. At 4, 24, 48, and 72 h after surgery, the serum levels of these inflammatory factors were the lowest in the combined group, and the PSQI scores were significantly lower in the combined group, when compared with the other two groups, while the control group had the highest PSQI scores among the three groups. There was no severe side effects and significant difference observed.ConclusionFICB combined with DEX reduced the postoperative pain, improved the sleep condition, and decreased the serum levels of inflammatory factors after total hip arthroplasty.

Highlights

Hip fractures are common in elder patients with osteoporosis, which result in a high rate of morbidity, reduced quality of life, and long-term care services [1,2,3,4]
The combined use of DEX and fascia iliaca compartment block (FICB) in pain condition after Total hip arthroplasty (THA) The pain condition for the different groups of patients was determined by the visual analog scale (VAS) score and patientcontrolled intravenous analgesia (PCIA) pressing times
The VAS scores at all time points were significantly lower in the FICB group when compared with the control group (P = 0.000, for all comparisons within the three groups at all points)

Summary

Introduction

Hip fractures are common in elder patients with osteoporosis, which result in a high rate of morbidity, reduced quality of life, and long-term care services [1,2,3,4]. Total hip arthroplasty (THA) is a widely adopted surgical method for end-stage hip fractures [5,6,7]. It has been estimated that approximately 572,000 cases may need THA in 2030 in the USA and that over 6.26 million patients may suffer from hip fractures in 2050 [8,9,10]. Despite the wide application of THA for femoral fractures, the postoperative pain management remains as a clinical challenge

Methods

Results

Discussion

Conclusion