Analgesia For Hip Arthroplasty Research Articles

Pericapsular Nervous Group Block versus Suprainguinal Fascia Iliaca Block Using the Same Injection Volume in Primary HIP Arthroplasty Prospective Observational Study

Objectives. To determine the pericapsular nerve group (PENG) block’s postoperative analgesic efficacy and safety compared to the suprainguinal fascia iliaca (SFI) block in patients undergoing primary hip arthroplasty using the same injectate volume. Material and Methods. Between January 2021 and March 2022, American Society of Anesthesiologists Physical Status (ASA-PS) classification I–III patients scheduled for hip arthroplasty were included in this study. After standard monitoring and subarachnoid anesthesia, an ultrasound-guided PENG or SFI block with 20 ml of 0.25% levobupivacaine was performed for postoperative analgesia. All patients were assessed with a numerical rating scale (NRS) at presurgery, upon arrival at the postanesthesia care unit (PACU), and in the postoperative period at 2, 4, 12, and 24 hours. The need for analgesic rescue and adverse effects was also assessed. Results. A total of 130 patients were included in the study (62 PENG block and 68 SFI block). Both blocks were equally effective in managing postoperative pain without any statistically significant differences except at 12 h (p=0.023), where the deviation found was not clinically relevant. The median total morphine consumption was 0 mg [0–2] in the PENG block group and 0 mg [0–2] in the SFI block group. A more significant motor block was found in the first 6 hours in the SFI block group (p=0.001). There was no significant difference in the ease of performing PENG (79%) or SFI (85%) blocks. No major complications were recorded in both groups, and patient satisfaction was high (83.9% for the PENG block group vs. 91.2% for the SFI block group). Discussion. Both blocks have been demonstrated to be effective for postoperative analgesia in hip arthroplasty and should be integrated as a multimodal analgesic strategy. The lesser degree of motor block recorded in the first hours with the PENG block makes it the most suitable option for early recovery. Both techniques were easy and safe to perform.

Pericapsular nerve group block in hip arthroplasty: A prospective randomized trial.

This study aimed to evaluate the analgesic effect of the ultrasound-guided pericapsular nerve group (PENG) block in hip arthroplasty (HA) surgery. A prospective double-blinded, randomized study. Tertiary institutional clinical care. Fifty patients, more than 50 years old of both genders, were chosen according to the American Society of Anesthesiologists classification, with physical status I-III, and scheduled for unilateral HA surgeries. Patients were randomized to receive either a sham PENG block with 20 mL of normal saline (control group) or a PENG block with 20 mL of bupivacaine 0.25 percent (PENG group). From the onset of the first request for rescue opioid analgesia, preoperative pain scores before and after block (at rest and with a raised straight leg), the incidence of quadriceps weakness after the block, intraoperative fentanyl consumption, post-operative pain scores, and morphine consumption, besides the presence and frequency of adverse events, were recorded. The patients undergoing PENG block with bupivacaine had prolonged durations before the first analgesic request, lower perioperative pain scores, less intraoperative rescue fentanyl, and less post-operative morphine consumption than the control group, with nonsignificant motor weakness after the block and similar adverse events. The PENG block provided effective perioperative analgesia for HA with prolonged duration of analgesia, nonsignificant motor effects, reduced perioperative opioids consumption, and no major side effects.

Ultrasound guided Fascia Iliaca Block versus Pericapsular Nerve Group for Postoperative Analgesia Prior to Spinal Anaesthesia for Hip Surgeries

For evaluating per capsular nerve group (PENG) block’s analgesic effect on elderly patient’s suffering from femoral neck fracture undergoing hip arthroplasty to provide a basis for optimizing perioperative analgesia in hip arthroplasty. This is a Prospective Observational study conducted in patients scheduled to undergo surgery for hip fracture under spinal anesthesia in Department of Anaesthesiology, Sapthagiri Institute of Medical Sciences and Research centre, Bengaluru, Karnataka. As per previous studies a total of 40 patients were included in the study over a period of 6 months. A prospective study was conducted after obtaining approval by the institutional ethics committee and informed written consent, patient scheduled for hip fracture surgery under spinal anesthesia based on inclusion criteria was randomly divided into two groups as group FIB and group PENG. Total 40 patients were included in the current study. The demographic data of both the groups are presented. There was no statistically significant difference in both groups with respect to demographic characteristics. VAS score for pain before nerve block between Group P (8.4 ± 0.58) and Group F (8.1 ± 0.61) was comparable (p = 0.9983).

Ultrasound guided Fascia Iliaca Block versus Pericapsular Nerve Group for Postoperative Analgesia Prior to Spinal Anaesthesia for Hip Surgeries

Introduction: For evaluating per capsular nerve group (PENG) block’s analgesic effect on elderly patient’s suffering from femoral neck fracture undergoing hip arthroplasty to provide a basis for optimizing perioperative analgesia in hip arthroplasty. Material and Method: This is a Prospective Observational study conducted in patients scheduled to undergo surgery for hip fracture under spinal anesthesia in Department of Anaesthesiology, Sapthagiri Institute of Medical Sciences and Research centre, Bengaluru, Karnataka. As per previous studies a total of 40 patients were included in the study over a period of 6 months. A prospective study was conducted after obtaining approval by the institutional ethics committee and informed written consent, patient scheduled for hip fracture surgery under spinal anesthesia based on inclusion criteria was randomly divided into two groups as group FIB and group PENG. Results: Total 40 patients were included in the current study. The demographic data of both the groups are presented. There was no statistically significant difference in both groups with respect to demographic characteristics. VAS score for pain before nerve block between Group P (8.4 ± 0.58) and Group F (8.1 ± 0.61) was comparable (p = 0.9983).

Ultrasound-guided lumbar ESP block for post-operative analgesia as an alternative mode of analgesia in hip arthroplasty with multiple systemic issues: a case report

BackgroundPatients with multiple systemic diseases present an anaesthetic challenge in terms of perioperative pain management. We propose that ultrasound-guided erector spinae plane block be used as an alternative mode of analgesia in patients undergoing hip arthroplasty.Case presentationWe report a case of a 54-year-old female, a known case of autosomal dominant polycystic kidney disease on continuous ambulatory peritoneal dialysis, hypertension, and deranged coagulation profile with fractured neck of femur planned for hemiarthroplasty. She was administered ultrasound-guided single-shot erector spinae plane block at L3 level with 20 mL of 0.25% ropivacaine and 4 mg dexamethasone. This block provided excellent post-operative analgesia for up to 24 h with early mobilisation.ConclusionSingle-shot ultrasound-guided erector spinae plane bock can be used as an alternative mode of analgesia in patients undergoing hip arthroplasty, with multiple systemic diseases in whom neuraxial blockade cannot be performed. This technique needs to be further explored in the form of randomised controlled trials.

Efficacy of ultrasound-guided fascia iliaca compartment block with ropivacaine and dexmedetomidine for postoperative analgesia in hip arthroplasty

Background Suprainguinal fascia iliaca block (FICB) has been reported to provide effective postoperative analgesia in patients with femur fracture. This study aimed to evaluate the effectiveness of FICB with ropivacaine and dexmedetomidine for postoperative analgesia in hip arthroplasty. Patients and methods This prospective, double-blinded, randomized, controlled, clinical study was conducted on 57 patients with American Society of Anesthesiology physical status I–II, aged 50–70 years, undergoing elective hip arthroplasty. Subarachnoid block was given at the L3-4 interspace, and then the patients were divided into three groups according to the drug given in the suprainguinal fascia iliaca after subarachnoid block and before skin incision: group C received 40 ml normal saline, group R received 40 ml ropivacaine 0.2%, and group D received a mixture of dexmedetomidine 2 μg/kg diluted in 0.2% ropivacaine with 40 ml total volume. The primary outcome was evaluation of postoperative analgesia using numerical rating scale, recorded at 30 min and at 1, 3, 6, 9, 12, 15, 18, 21, and 24 h. Analgesic consumption and first analgesic request were the secondary outcomes. Results Numerical rating scale scores were significantly higher in group C when compared with groups R and D, at the 1, 3, and 6 h. Postoperative pethidine consumption during the first 24 h was found to be significantly less in group R and group D when compared with group C. There was a statistically significant difference in the group D when compared with group C and group R, with less number of patients who required rescue analgesic in 24 h and prolonged time for first request of rescue analgesic. Conclusion Addition of dexmedetomidine to ropivacaine in FICB was efficacious in decreasing severity of pain, decreasing total analgesic consumption during the first 24 h, and prolonging the time for first request of analgesia in the postoperative period for patients undergoing hip arthroplasty.

Ropivacaine pharmacokinetics after local infiltration analgesia in hip arthroplasty.

In this study, we determined the plasma concentration of ropivacaine by liquid chromatography-mass spectrometry for 30 hours after local infiltration analgesia in 15 patients with elective hip arthroplasty. The 95% upper prediction bound of maximal unbound plasma concentration of ropivacaine was 0.032 mg/L. Side effects sufficient to stop an IV infusion have been reported at arterial concentrations of 0.34 to 0.85 mg/L. Alpha-1-acid glycoprotein did not correlate with the fraction of unbound ropivacaine during the first 24 hours after local infiltration analgesia. No signs or symptoms of systemic local anesthetic toxicity were observed. The Clopper-Pearson 95% upper confidence limit for adverse signs was 0.218.

Plasma concentration of ketorolac after local infiltration analgesia in hip arthroplasty.

Local infiltration analgesia (LIA) with local anaesthetic (ropivacaine), a nonsteroidal anti-inflammatory drug (ketorolac) and epinephrine after lower extremity arthroplasty has gained increasing popularity during the last decade. This method has certain advantages, which include minimal systemic side effects, faster post-operative mobilization, earlier post-operative discharge from hospital and less opioid consumption. However, information regarding plasma concentrations of ketorolac after LIA mixture is insufficient to predict the risk of renal impairment in patients subjected to arthroplasty. To determine the maximal plasma concentration and the exposure of ketorolac during the first 30 h following LIA in hip arthroplasty. Thirteen patients scheduled for primary total hip arthroplasty with LIA (ropivacaine 200 mg, ketorolac 30 mg and epinephrine 0.5 mg in a volume of 106 ml) were included. Plasma concentration of ketorolac was quantified by liquid chromatography-mass spectrometry. In addition, we assessed the effect of increasing age and decreasing glomerular filtration rate on the maximal plasma concentration and the total exposure to ketorolac during 30 h. The range of the maximal plasma concentration, 0.3-2.2 mg/l, was detected 30 min-4 h after completing the infiltration. Similar plasma levels have been reported after intramuscular injection of the same dose of ketorolac to healthy elderly volunteers. Exposure to ketorolac after LIA may be comparable to an intramuscular injection of the same dose. Decision of dose reduction should be based on clinical assessment of risk factors.