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Ultrasound-guided suprainguinal fascia iliaca compartment block versus periarticular infiltration for pain management after total hip arthroplasty: a randomized controlled trial
  1. Irina Gasanova1,
  2. John C Alexander1,
  3. Kenneth Estrera2,
  4. Joel Wells2,
  5. Mary Sunna3,
  6. Abu Minhajuddin4 and
  7. Girish P Joshi1
  1. 1 Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, Texas, USA
  2. 2 Department of Orthopedics, UT Southwestern Medical Center, Dallas, Texas, USA
  3. 3 Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
  4. 4 Parkland Health and Hospital System, Dallas, Texas, USA
  1. Correspondence to Irina Gasanova, University of Texas Southwestern Medical Center, Dallas, TX 5323, USA; irina.gasanova{at}utsouthwestern.edu

Abstract

Background and objectives Fascia iliaca compartment block (FICB) has been shown to provide excellent pain relief in patients undergoing total hip arthroplasty (THA). However, the analgesic efficacy of FICB, in comparison with periarticular infiltration (PAI) for THA, has not been evaluated. This randomized, controlled, observer-blinded study was designed to compare suprainguinal FICB (SFICB) with PAI in patients undergoing THA via posterior approach.

Methods After institutional review board approval, 60 consenting patients scheduled for elective THA were randomized to one of two groups: ultrasound-guided SFICB block or PAI. The local anesthetic solution for both the groups included 60 mL ropivacaine 300 mg and epinephrine 150 µg. The remaining aspects of perioperative care, including general anesthetic and non-opioid multimodal analgesic techniques, were standardized. An investigator blinded to group allocation documented pain scores at rest and with movement and supplemental opioid requirements at various time points. Patients were evaluated for sensory changes and quadriceps weakness in the operated extremity.

Results There were no differences between the groups with respect to demographics, intraoperative opioid use, duration of surgery, recovery room stay, nausea scores, need for rescue antiemetics, time to ambulation and time to discharge readiness as well as 48 hours postoperative opioid requirements. The pain scores at rest and with movement also were similar at all time points. Significantly more patients in the SFICB group experienced muscle weakness at 6 hours after surgery.

Conclusions Under the circumstances of our study, in patients undergoing THA, SFICB provided the similar pain relief compared with PAI, but was associated with muscle weakness at 6 hours postoperatively.

Trial registration number NCT02658240.

  • total hip arthroplasty
  • suprainguinal fascia iliaca compartment block
  • periarticular infiltration
  • multimodal analgesia
  • postoperative pain management

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Footnotes

  • Presented at Interim data from this work were presented at the 2018 World Congress on Regional Anesthesia and Pain Medicine in New York, NY, 19 April to 21 April 2018.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests GPJ has received honoraria from Pacira Pharmaceuticals (Exparel), Baxter Pharmaceuticals, Mallinckrodt Pharmaceuticals, and Merck Pharmaceuticals.

  • Patient consent Obtained

  • Ethics approval This study was approved by the Institutional Review Board of University of Texas Southwestern Medical Center, Dallas, Texas, USA.

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