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Postoperative Analgesia After Total-Hip Arthroplasty: Comparison of Intravenous Patient-Controlled Analgesia With Morphine and Single Injection of Femoral Nerve or Psoas Compartment Block. a Prospective, Randomized, Double-Blind Study
  1. Philippe Biboulet, M.D.,
  2. Didier Morau, M.D.,
  3. Pierre Aubas, M.D.,
  4. Sophie Bringuier-Branchereau, Pharm.D. and
  5. Xavier Capdevila, M.D., Ph.D.
  1. From the Department of Anesthesiology and Critical Care, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
  2. Department of Medical Information, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
  1. Reprint requests: Philippe Biboulet, M.D., Département d'Anesthésie Réanimation A, Hôpital Lapeyronie, 371 avenue du doyen G. Giraud, 34295 Montpellier Cedex 5, France. E-mail: p-biboulet{at}chu-montpellier.fr

Abstract

Background The authors compared the analgesic effects and quality of rehabilitation of three analgesic techniques after total-hip arthroplasty in a double-blind, randomized trial.

Methods Forty-five patients were assigned to 1 of 3 groups, patient-controlled analgesia with morphine (PCA), femoral nerve block (FNB), or psoas compartment block (PCB). At the end of the procedure performed under general anesthesia, nerve blocks using 2 mg/kg of 0.375% bupivacaine and 2 μg/kg of clonidine were performed in the FNB (n = 16) and PCB (n = 15) groups. In the recovery room, all 3 groups received initial intravenous morphine titration if their pain score was higher than 30 on a 100-mm visual analog scale (VAS), and then a PCA device was initiated. Morphine consumption was the primary end point to assess postoperative analgesia.

Results After extubation (H0), morphine titration was higher in the PCA group (P < .05). During the first 4 postoperative hours (H0 to H4), morphine consumption per hour and VAS pain score were lower in the PCB group (P < .05). After H4, there was no difference in morphine consumption and VAS among groups, either at rest or during mobilization. After H4, morphine consumption remained lower than 0.5 mg/h, and VAS remained lower than 30 mm in the 3 groups. In 4 patients of the PCB group, an epidural diffusion was noted. Hip mobility and length of stay in the rehabilitation center were not different among the groups.

Conclusions PCA is an efficient and safe analgesia technique. FNB and PCB should not be used routinely after total-hip arthroplasty.

  • Local anesthetics
  • Regional anesthesia
  • Physiotherapy
  • Hip surgery

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Footnotes

  • Presented in part at the annual meeting of the American Society of Anesthesiologists, San Francisco, California, October 14-18, 2000.

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