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Effects of Intravenous Patient-Controlled Analgesia With Morphine, Continuous Epidural Analgesia, and Continuous Femoral Nerve Sheath Block on Rehabilitation After Unilateral Total-Hip Arthroplasty
  1. François J. Singelyn, M.D., Ph.D.,
  2. Tanguy Ferrant, M.D.,
  3. Marie F. Malisse, M.D. and
  4. Daniel Joris, P.T.
  1. From the Department of Anesthesiology (F.J.S., T.F., M.F.M.) and Physiotherapy, Université Catholique de Louvain School of Medicine (D.J.), St Luc Hospital, Brussels, Belgium
  1. Reprint requests: FJ Singelyn, MD, PhD. Department of Anesthesiology, St Luc Hospital, Avenue Hippocrate 10/1821-1200, Brussels, Belgium. E-mail: singelyn{at}anes.ucl.ac.be

Abstract

Background and Objectives Regional analgesic techniques allow better postoperative rehabilitation and shorter hospital stay after major knee surgery. The authors tested the hypothesis that similar results could be obtained after total-hip arthroplasty.

Methods Forty-five patients scheduled for THA under general anesthesia were randomly divided into 3 groups. Postoperative analgesia was provided during the first 48 hours, with intravenous patient-controlled analgesia (IV PCA) induced by morphine (dose, 1.5 mg; lockout interval, 8 min) in group IV, continuous femoral nerve sheath block in group FNB, and continuous epidural analgesia in group EPI. The day after surgery, the 3 groups started identical physical therapy regimens. Pain scores at rest and on movement, supplemental analgesia, side effects, daily degree of maximal hip flexion and abduction, day of first walk, and duration of hospital stay were recorded.

Results Population data, quality of pain relief, postoperative hip rehabilitation, and duration of hospital stay were comparable in the 3 groups. When compared with the two other techniques, continuous FNB was associated with a lower incidence of side effects (no nausea/vomiting, urinary retention, arterial hypotension, or catheter problem during the first 48 hours in 20%, 60%, and 13% of patients in groups IV, FNB, and EPI, respectively).

Conclusions This study suggests that IV PCA with morphine, continuous FNB, and continuous epidural analgesia provide similar pain relief and allow comparable hip rehabilitation and duration of hospital stay after total-hip arthroplasty (THA). As continuous FNB is associated with less side effects, it appears to offer the best option of the three.

  • Hip surgery
  • Total arthroplasty
  • Analgesic technique
  • IV PCA
  • PCEA
  • Continuous femoral nerve sheath block
  • Regional technique
  • Continuous epidural

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Footnotes

  • This work was supported only with funds from the Department of Anesthesiology, UCL School of Medicine.

    This paper was presented in part at the 2001 Annual Meeting of the American Society of Regional Anesthesia, Vancouver, Canada.

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