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Obturator nerve block does not provide analgesic benefits in total hip arthroplasty under multimodal analgesic regimen: a randomized controlled trial
  1. Philippe Marty1,
  2. Clement Chassery1,
  3. Olivier Rontes1,
  4. Corine Vuillaume1,
  5. Bertrand Basset1,
  6. Mehdi Merouani1,
  7. Constance Marquis1,
  8. Anne Delussy1,
  9. Marie-Claude Delbos1,
  10. Fabrice Ferre2,
  11. Benoit Bataille3,
  12. Girish Joshi4 and
  13. Alain Delbos1
  1. 1Department of Anesthesia, Clinique Medipole Garonne, Toulouse, Occitanie, France
  2. 2Department of Anesthesia, Hôpital Purpan, Toulouse, Midi-Pyrénées, France
  3. 3Department of Anesthesia and Intensive Care, Narbonne Hospital Orthopedic and Trauma Surgery, Narbonne, Occitanie, France
  4. 4Department of Anesthesiology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
  1. Correspondence to Dr Philippe Marty, Department of Anesthesia, Clinique Medipole Garonne, Toulouse, Occitanie, France; philippemarty{at}hotmail.com

Abstract

Background and objectives Although regional analgesia is considered an important component of optimal pain management, use of peripheral nerve blocks for total hip arthroplasty remains controversial. Since the obturator nerve innervates the anteromedial part of the joint capsule, we hypothesized that an obturator nerve block would decrease the opioid consumption after total hip arthroplasty.

Methods In this single center, prospective, triple blinded study, we randomly allocated 60 patients undergoing total hip arthroplasty under opioid-sparing total intravenous general anesthesia to a preoperative obturator nerve block or a sham block (placebo group) using 20 mL of ropivacaine 0.2% or saline, respectively. All patients received a multimodal analgesic regimen with non-opioid analgesics including periarticular local infiltration analgesia. The primary outcome was the intravenous opioid consumption in the post-anesthesia care unit.

Results Median (IQR) intravenous oxycodone consumption in the post-anesthesia care unit was 4 (2, 7.5) mg in the obturator nerve block group and 3 (0, 4) mg in the placebo group (p=0.05). There were no differences in pain scores between groups in the first 24 hours except at arrival on the surgical ward with significant higher pain scores in the placebo group (p=0.03). The ability to stand up and walk within 24 hours was comparable between groups as was the time to first walk (180 (90, 720) vs 240 (120, 780) min for the obturator nerve block and placebo groups, respectively; p=0.62).

Conclusions Obturator nerve block did not improve postoperative opioid consumption after total hip arthroplasty performed under general anesthesia with a multimodal analgesic regimen.

Trial registration number NCT04085640.

  • analgesia
  • nerve block
  • pain
  • postoperative
  • pain management
  • lower extremity

Data availability statement

Data (deidentified participant data) are available upon reasonable request. Contact details: philippemarty@hotmail.com.

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Data availability statement

Data (deidentified participant data) are available upon reasonable request. Contact details: philippemarty@hotmail.com.

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Footnotes

  • Contributors CC, PM, ADelbos contributed to study design/ planning. BBas, CC, ADelb, ADelu, CM, PM, MM, OR, CV, MCD contributed to data collection. BBat contributed to data analysis. CC, PM, FF, GJ contributed to writing, drafting and revision of the paper.

  • Funding This work should be attributed to the department of anesthesiology, Clinique Medipole Garonne, Toulouse, France. Support was provided solely from institutional and department sources from the department of anesthesiology, Clinique Medipole Garonne, Toulouse, France.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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