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Regional Anesthesia and Acute Pain: Original Article
A Longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphine Consumption After Total Hip Arthroplasty
  1. Matthias Desmet, MD*,
  2. Kris Vermeylen, MD†,
  3. Imré Van Herreweghe, MD‡,
  4. Laurence Carlier, MD‡,
  5. Filiep Soetens, MD†,
  6. Stijn Lambrecht, PharmD, PhD§,
  7. Kathleen Croes, PharmD, PhD§,
  8. Hans Pottel, PhD∥ and
  9. Marc Van de Velde, MD, PhD‡
  1. *Department of Anaesthesia, AZ Groeninge, Kortrijk, Belgium
  2. †Department of Anaesthesia, AZ Turnhout, Turnhout, Belgium
  3. ‡Department Cardiovascular Sciences, KU Leuven, Department of Anesthesiology, UZ Leuven, Leuven, Belgium
  4. §Clinical Laboratory, AZ Groeninge, Kortrijk, Belgium
  5. ∥Department of Public Health and Primary Care, KU Leuven Campus Kulak, Kortrijk, Belgium
  1. correspondence: Matthias Desmet, MD, AZ Groeninge Hospital, Loofstraat 43, 8500 Kortrijk, Belgium (e-mail: Matthias.Desmet{at}azgroeninge.be).

Abstract

Background and Objectives The role of a fascia iliaca compartment block (FICB) for postoperative analgesia after total hip arthroplasty (THA) remains questionable. High-dose local anesthetics and a proximal injection site may be essential for successful analgesia. High-dose local anesthetics may pose a risk for local anesthetic systemic toxicity. We hypothesized that a high-dose longitudinal supra-inguinal FICB is safe and decreases postoperative morphine consumption after anterior approach THA.

Methods We conducted a prospective, double blind, randomized controlled trial. Patients scheduled for THA were randomized to group FICB (longitudinal supra-inguinal FICB with 40-mL ropivacaine 0.5%) or group C (control, no block). Standard hypothesis tests (t test or Mann-Whitney U test, χ2 test) were performed to analyze baseline characteristics and outcome parameters. The primary end point of the study was total morphine (mg) consumption at 24 hours postoperatively. Serial total and free ropivacaine serum levels were determined in 10 patients.

Results After obtaining ethical committee approval and written informed consent, 88 patients were included. Mean (SD) morphine consumption at 24 hours postoperatively was reduced in group FICB compared to group C: 10.25 (1.64) mg versus 19.0 (2.4) mg (P = 0.004). Using a mean dose of 2.6-mg/kg ropivacaine (range, 2–3.4 mg/kg), none of the patients had total or free ropivacaine levels above the maximum tolerated serum concentration.

Conclusions We conclude that a high-dose longitudinal supra-inguinal FICB reduces postoperative morphine requirements after anterior approach THA.

Clinical Trials Registry: EU Clinical Trials Register. www.clinicaltrialsregister.eu #2014-002122-12.

https://doi.org/10.1097/AAP.0000000000000543

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    Footnotes

    • The Department of Anesthesiology of the University Hospitals Gasthuisberg, University of Leuven, provided financial support for this work.

      The authors declare no conflict of interest.

      This work was presented in part at the 34th Annual ESRA congress (Ljublijana 2015).

      Drs. Matthias Desmet and Kris Vermeylen equally contributed to this manuscript.