Background and aims Revision total hip arthroplasty (RTHA) results in severe postoperative pain necessitating increased length of stay and associated complications. Anecdotal evidence suggests these patients’ time for discharge (TFD) is >10 days. Prospective audit conducted to assess the quality of analgesia, complications and length of stay using U/S guided Shamrock Psoas Catheter (USPC) for RTHA.
Methods Prospective audit on 26 patients over 9 months. Pajunk e-catheter inserted towards the end of the operation with the patient in the lateral position. All patients received standard spinal anaesthetic (0.5% bupivacaine heavy +300mcg diamorphine) and general anaesthetic. Patients are given 10 mls of 0.125% chirocaine plain after catheter insertion in the psoas compartment (in-plane approach using curvilinear probe). Subsequently, connected to a elastometric (Braun) pump@5 mls/hr. Patients are followed up for three consecutive days for pain scores, rescue analgesia, motor weakness, days to weight bear, TFD and their experience. 1/26 patients were removed from the data due to a confounding factors, including a deep seated infection and sadly death after 6 weeks.
Results After removing a patient with confounding factors, data suggests psoas catheters are associated with a pain scores of <1(scale of 0–4), average use of rescue analgesia Oxynorm (short acting morphine) 2.6 mgs, ability to weight bear 1.2 days, no residual motor weakness by day 3, average TFD 3.14 days, with all 25 patients recommending this technique to other patients.
Conclusions Continuous psoas compartment nerve block provides an effective analgesia with no complications and reduced TFD. Research is required to replicate these results in a controlled trial to assess the incidence of complications associated with this practice.