Combination Therapy with Continuous Three-in-One Femoral Nerve Block and Periarticular Multimodal Drug Infiltration after Total Hip Arthroplasty

Tomonori Tetsunaga,Hirosuke Endo,Kazuo Fujiwara,Tomoko Tetsunaga,Toshifumi Ozaki

doi:10.1155/2016/1425201

Tomonori Tetsunaga, Hirosuke Endo + Show 3 more

Open Access

https://doi.org/10.1155/2016/1425201

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Abstract

Background. Various postoperative pain relief modalities, including continuous femoral nerve block (CFNB), local infiltration analgesia (LIA), and combination therapy, have been reported for total knee arthroplasty. However, no studies have compared CFNB with LIA for total hip arthroplasty (THA). The aim of this study was to compare the efficacy of CFNB versus LIA after THA. Methods. We retrospectively reviewed the postoperative outcomes of 93 THA patients (20 men, 73 women; mean age 69.2 years). Patients were divided into three groups according to postoperative analgesic technique: CFNB, LIA, or combined CFNB+LIA. We measured the following postoperative outcome parameters: visual analog scale (VAS) for pain at rest, supplemental analgesia, side effects, mobilization, length of hospital stay, and Harris Hip Score (HHS). Results. The CFNB+LIA group had significantly lower VAS pain scores than the CFNB and LIA groups on postoperative day 1. There were no significant differences among the three groups in use of supplemental analgesia, side effects, mobilization, length of hospital stay, or HHS at 3 months after THA. Conclusions. Although there were no clinically significant differences in outcomes among the three groups, combination therapy with CFNB and LIA provided better pain relief after THA than CFNB or LIA alone, with few side effects.

Highlights

Acute postoperative pain is a distinct risk factor for prolonged pain [1]
Three patients (8.6%) in the continuous femoral nerve block (CFNB) group, two (6.3%) in the local infiltration analgesia (LIA) group, and three (9.7%) in the CFNB+LIA group had nausea/ vomiting, patients consumed 71.8% of food offered on the first postoperative day
Our results indicate that combined CFNB and LIA provided significantly better pain relief on the first postoperative day than either modality alone

Summary

Introduction

Acute postoperative pain is a distinct risk factor for prolonged pain [1]. Postoperative pain relief after joint surgery can be achieved with various modalities, such as patient-controlled analgesia (PCA) with morphine, epidural analgesia, and lumbar plexus and/or sciatic blocks [2,3,4,5,6]. The advantages of PCA include fewer technical problems than other modalities and uniform, sustained analgesia with autonomy [7, 8] Both PCA and continuous epidural analgesia provide sufficient pain relief, they are associated with multiple side effects, including arterial hypotension, respiratory depression, nausea/vomiting, and urinary retention [6]. Various postoperative pain relief modalities, including continuous femoral nerve block (CFNB), local infiltration analgesia (LIA), and combination therapy, have been reported for total knee arthroplasty. We measured the following postoperative outcome parameters: visual analog scale (VAS) for pain at rest, supplemental analgesia, side effects, mobilization, length of hospital stay, and Harris Hip Score (HHS). There were no clinically significant differences in outcomes among the three groups, combination therapy with CFNB and LIA provided better pain relief after THA than CFNB or LIA alone, with few side effects

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