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Abstract
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Background and Aims THA is associated with severe postoperative pain. SIFIB is a reliable analgesic option as a part of multimodal analgesia, reducing pain, opioid consumption and its related adverse effects. Adequate pain control is important for early ambulation and patient satisfaction. However, SIFIB may potentially lead to decreased motor strength of quadriceps, delaying physical rehabilitation and discharge.
Methods We report a case of a middle-aged male submitted to right THA using SPAIRE technique for treatment of coxarthrosis.
Results A 43-year-old male (ASA I, BMI 21) was scheduled for elective uncemented THA. A spinal single-shot block through the L3/L4 intervertebral space (paravertebral approach), in left lateral decubitus position, was achieved after 3 attempts, with a 27G Quincke needle and injection of 9mg of levobupivacaine and 2ug of sufentanyl. Intraoperative course lasted 90 minutes and was uneventful. Acetaminophen (1g), ketorolac (30mg) and dexamethasone (8mg) were administered. An ultrasound-guided SIFIB was performed post-operatively, using a 50mm echogenic needle and 20mL of 2mg/dL of ropivacaine, without complications. After 48h, the patient had right quadriceps motor weakness (2-3/5) and hypoesthesia of L2-L4 dermatomes. A spine and hip CT scan were negative. Dexamethasone, gabapentin, cyanocobalamin, pyridoxine and thiamine were prescribed. After 72h, physical examination was normal (muscular strength 4-4.5/5 with no sensory changes). One month later no sequelae were observed.
Sagittal section of spine CT-scan
Axial CT-scan of pelvis
Axial CT-scan at the body level of SIFIB
Conclusions SIFIB is an easy to perform and safe block that provides analgesia for hip joint and femur procedures, facilitating postoperative rehabilitation. Sensory and motor block can delay mobilization, but with no nerve damage, sequelae are unlikely.