Comparative Supra-Inguinal Fascia Iliaca Compartment Block and Continuous Lumbar Epidural Analgesia for Total Hip Replacement: A Retrospective Study

Abstract

Background: Optimal pain control is one of the major concerns in total hip arthroplasty (THA). Lumbar epidural analgesia (LEA) is considered a common modality for pain relief following THA. However, the benefits must be weighed against the possibility of adverse effects and complications. Supra-inguinal fascia iliaca compartment block (S-FICB) is an alternative to neuraxial analgesia and provides adequate analgesia with fewer adverse effects. Objective: To compare the efficacy of postoperative analgesia between S-FICB and LEA in THA patients. Material and Methods: The present study was a retrospective cohort study that included 58 patients who underwent THA. Thirty-nine patients received LEA and 19 patients received S-FICB. Numeric rating score (NRS) at rest and movement, morphine (MO) consumption, complications/side-effects, and satisfaction score were collected at 24 and 48 hours postoperative. Results: Twenty-four hours NRS at rest was lower in LEA group (median resting NRS: 0 (0, 1) versus 4 (2, 4), p=0.0003). Twenty-four hours MO equivalent consumption was also lower in LEA group (MO equivalent consumption (mg): 0 (0, 5) versus 3 (0, 6), p=0.027). However, intraoperative blood loss was higher in LEA group compared with S-FICB group (median BL: 600 mL (500, 1,000) versus 400 mL (250, 700), p=0.02). The incidence of itching was higher in LEA group. However, the satisfaction score, the incidence of hypotension, nausea/vomiting, and dizziness were not statistically different. Conclusion: LEA provided superior analgesic efficacy than S-FICB. However, LEA is associated with higher incidence of blood loss and itching. The length of hospital stays and level of patient satisfaction with the analgesic treatment were comparable between the two groups. Keywords: Total hip arthroplasty; Epidural; Fascia iliaca; Postoperative analgesia