Effects of ultrasound-guided combinatorial block of fascia iliaca compartment and ilioinguinal/iliohypogastric nerves on postoperative analgesia in elderly patients with hip replacement

Abstract

Objective To observe effects of ultrasound-guided combinatorial block of fascia iliaca compartment and ilioinguinal/iliohypogastric nerves on postoperative analgesia in elderly patients with hip replacement. Methods A total of fifty 61 to 84 years old patients with ASA category of Ⅱ or Ⅲ were enrolled in this study. These patients received total hip replacement via unilateral approach under general anesthesia between April and October in 2015. The patients were randomly divided into 2 groups(n=25): fascia iliaca block only(FI group) and fascia iliacus block combined with ilioinguinal/iliohypogastric nerve block group (combined group). Immediately after the operation, the patients received ipsilateral nerve block with 0.3% ropivacaine under the guidance of ultrasound. We recorded general parameters of the patients, including resting and motion VAS scores, ultrasound imaging time, puncture administration time, cumulative dosage of fentanyl, and incidences of various adverse reactions. Results There was no statistical difference between the two groups of patients in general parameters and resting pain scores at each time point after operation. Compared with FI group, motion pain scores of the combined group decreased at postoperative 6 h and 12 h, while there was no statistical difference in motion pain scores at postoperative 18 h and 24 h. There was no statistical difference between the two groups of patients in ultrasound imaging time and puncture administration time. Compared with the FI group, the combined group had smaller cumulative dosage of fentanyl for patient controlled analgesia(PCA). There was no statistical difference between the two groups of patients in incidences of postoperative analgesia-related adverse reactions. Conclusions Ultrasound-guided combinatorial block of fascia iliaca compartment and ilioinguinal/iliohypogastric nerve is safe and effective for postoperative analgesia in elderly patients receiving total hip replacement. It can significantly alleviate patients′ pain and reduce the dosage of fentanyl. Key words: Nerve block; Ultrasonography; Arthroplasty, hip, replacement; Analgesia; Aged