Effectiveness of Fascia Iliaca Compartment Block after Elective Total Hip Replacement: A Prospective, Randomized, Controlled Study.

Wojciech Gola,Aleksander J Owczarek,Szymon Bialka,Hanna Misiolek

doi:10.3390/ijerph18094891

Abstract

Objective: An assessment of the feasibility of fascia iliaca compartment block (FICB) combined with nonopioid analgesics and patient controlled analgesia (PCA), oxycodone, in the perioperative anaesthetic management for elective total hip replacement (THR). Design: A randomised, single-center, open-label study. Setting: A single hospital. The study was conducted from October 2018 to May 2019. Participants: In total, 109 patients were scheduled for elective total hip replacement. Interventions: Postoperative FICB with 0.375% ropivacaine in conjunction with nonopioid analgesics (paracetamol, metamizole, and pregabalin) and oxycodone as rescue analgesia. Measurements: Pain intensity was measured using the Numeric Pain Rating Scale (NRS) at rest and during rehabilitation, the total dose of postoperative oxycodone required, the occurrence of opioid-related adverse events, patient hospitalisation time, and level of satisfaction. Follow-up period: 48 h. Main Results: A total of 109 patients were randomised into two groups and, of these, 9 were subsequently excluded from the analysis (three conversions to general anaesthesia, two failures to perform FICB, four failures to use the PCA pump). Patients in the FICB group received standard intravenous analgesia with FICB, and those in the control group were managed with standard intravenous analgesia only. Pain level measured with NRS was significantly lower at rest and during rehabilitation in the FICB group. Oxycodone use in the first 48 h was significantly higher in the control group (p < 0.001); additionally, the time to the first dose of rescue analgesia was significantly shorter (p < 0.001). In the control group, there was a higher rate of side effects and a significantly longer hospitalisation time (p < 0.001). Similarly, higher satisfaction with the applied analgesic treatment was noted in the FICB group. Conclusions: FICB in elective THR treatments is an effective form of analgesia, which reduces the need for opioids, the number of complications, the length of hospitalisation, and which ensures a high level of patient satisfaction with the analgesic treatment used. Trial registration: ClinicalTrials.gov No. NCT04690647.

Highlights

This article is an open access articleThe development of joint reconstructive surgery is considered to be one of the most important advances in interventional orthopaedics in recent years [1,2]
fascia iliaca compartment block (FICB) in elective Total hip replacement (THR) treatments is an effective form of analgesia, which reduces the need for opioids, the number of complications, the length of hospitalisation, and which ensures a high level of patient satisfaction with the analgesic treatment used
Three patients were not randomised due to the need for conA total of 109 patients scheduled for elective total posterolateral hip replacement were version from spinal to general anaesthesia

Summary

Introduction

This article is an open access article. The development of joint reconstructive surgery is considered to be one of the most important advances in interventional orthopaedics in recent years [1,2]. Total hip replacement (THR) is a treatment of choice for the advanced osteoarthritis of the hip joint [1,3,4]. The number of THR procedures is constantly growing due to the increasingly broader indications and social awareness, as well as a longer professional activity and improved distributed under the terms and conditions of the Creative Commons.

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