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OP042 Comparison between periarticular infiltration, pericapsular nerve group and suprainguinal fascia iliaca blocks on postoperative functional recovery in total hip arthroplasty: preliminary results from a randomized controlled clinical study
  1. Michele Carella,
  2. Florian Beck,
  3. Nicolas Piette,
  4. Jean-Pierre Lecoq and
  5. Vincent Bonhomme
  1. Anesthesia and Intensive Care, Liège University Hospital, Liège, Belgium

Abstract

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Background and Aims Pain after posterolateral-approached total hip arthroplasty (PLTHA) may affect early functional recovery. Periarticular infiltration (PAI), pericapsular nerve group (PENG) or supra-inguinal fascia iliaca (SFIB) blocks have been proposed to provide adequate analgesia but SFIB as opposed to PAI and PENG may potentially impair quadriceps strength. Our aim was to compare these techniques regarding functional recovery during the first 48 hours following PLTHA.

Methods Thirty consenting patients scheduled for PLTHA with spinal anesthesia were prospectively and randomly allocated into three groups. Patients received either SFIB [40mL ropivacaine 0.375% (SFIB group) or saline (PAI group)], or PENG [20mL ropivacaine 0.75% (PENG group)]. They also received PAI [40mL ropivacaine 0.375% (PAI group) or saline (SFIB and PENG groups)]. A blinded observer noted the evolution of quality of recovery-15 (QoR-15) score, timed-up-and-go (TUG), 2-minutes (2MWT) and 6-minutes-walking (6MWT) tests 1-day before surgery (D-1), and at day-1 (D1) and day-2 (D2) after surgery. Data were analyzed using generalized linear mixed model tests.

Results Time-group interaction was significant for TUG (P=0.04), 2MWT (P<0.01), 6MWT (P<0.01) and QoR-15 (P<0.01). At D2, post hoc comparisons revealed that the PAI group had shorter walking distance (2MWT) than the PENG group, and that the PENG group had a better 6MWT performance than the PAI or SFIB group. QoR-15 remained comparable between groups (figure 1).

Evolution of French validated Quality of Recovery-15 items, distance walked (meters) at the 2-minute walk test (2-MWT) and 6-minute walking test (6-MWT), and time taken (seconds) to perform the Timed Up and Go test (TUG), over the time points of interest (D–1= 1 one day before surgery; D1 = one day after surgery; D2 = 2 days after surgery) in group SFIB (dark grey), group PAI (light grey) and in group PENG (white). Numbers have been rounded up to the first decimal, with the 95% confidence interval (95% CI) of the means and of the mean difference (MD). Box plot of results obtained in each group. Bold line = median; lower error bar = minim data value; lower box limit = lower quartile; upper box limit = upper quartile; upper error bar = maximum data value; dot = outlier.

Conclusions In PLTHA, PENG is superior to PAI and SFIB regarding early walking ability, despite similar functional recovery as assessed by the QoR-15. These results need to be confirmed once the planned sample size (219) will have been recruited.

  • PENG block
  • fascia iliaca block
  • periarticular infiltration
  • hip replacement
  • functional recovery

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