Objective: Total hip arthroplasty (THA) results in severe postoperative pain requiring hospitalization to provide potent analgesia. Consequently, the average duration of hospitalization after THA in the United States is 4 to 5 days. This prospective study investigated the feasibility of converting THA into an overnight-stay procedure using a continuous psoas compartment nerve block provided at home with a portable infusion pump.
Case Report: Preoperatively, patients undergoing THA had a psoas compartment perineural catheter placed. Postoperatively, perineural ropivacaine 0.2% was delivered through postoperative day (POD) 4. Patients were discharged home when they met specific, prospectively defined criteria, as early as POD 3 for the first phase and POD 1 for the second phase. Of the patients in the first phase (n = 7) who remained hospitalized for at least 3 postoperative nights, 5 met discharge criteria on POD 1 and the remainder on POD 2. Of the patients in phase 2 (n = 5), all but 1 met discharge criteria on POD 1 and 3 were discharged directly home on POD 1. Postoperative pain was well controlled, opioid requirements and sleep disturbances were minimal, and patient satisfaction high.
Conclusions: These results suggest that for a subset of patients without major comorbidities, it is feasible to convert THA into an overnight-stay procedure using an ambulatory continuous psoas compartment nerve block as part of a multimodal analgesic regimen provided at home. Additional research is required to replicate these results in a controlled trial, define the appropriate subset of patients, and assess the incidence of complications associated with this practice before its mainstream use.
- Ambulatory surgery
- Continuous nerve block
- Continuous peripheral nerve block
- Patient-controlled regional analgesia
- Perineural local anesthetic infusion
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Supported by the University of Florida Department of Anesthesiology, B Braun Medical Inc, Stryker Instruments, and the National Institutes of Health, National Institute of General Medical Sciences (grant no. K23-GM077026). Also supported in part by General Clinical Research Center (grant no. M01-RR00082). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of these entities. B. Braun Medical Inc. and Stryker Instruments had no input into any aspect of study conceptualization, initiation, and design; data collection, analysis, and interpretation; or manuscript preparation.
Manufacturers donated the portable infusion pumps (Stryker Instruments, Kalamazoo, MI) and perineural catheters (B Braun Medical Inc, Bethlehem, PA) used for this investigation.
Presented in part at the Annual Meeting of the American Society of Anesthesiologists, Atlanta, Georgia, October 25, 2005.