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Effect of suprainguinal fascia iliaca compartment block on postoperative opioid consumption and functional recovery in posterolateral-approached total hip arthroplasty: a single-blind randomized controlled trial
  1. Michele Carella1,
  2. Florian Beck1,
  3. Nicolas Piette1,
  4. Sébastien Denys2,
  5. William Kurth3,
  6. Jean-Pierre Lecoq1 and
  7. Vincent L Bonhomme1,4
  1. 1Department of Anesthesia and Intensive Care Medicine, Central University Hospital of Liege, Liege, Belgium
  2. 2Department of Physical Medicine, Rehabilitation and Sports Traumatology, Central University Hospital of Liege, Liege, Belgium
  3. 3Department of Locomotor System Surgery, Central University Hospital of Liege, Liege, Belgium
  4. 4Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
  1. Correspondence to Dr Michele Carella, Department of Anesthesia and Intensive Care Medicine, Central University Hospital of Liege, Liege, Belgium; mcarella{at}chuliege.be

Abstract

Introduction Posterolateral-approached total hip arthroplasty (PLTHA) is followed by moderate to severe postoperative pain. Suprainguinal fascia iliaca compartment block (SFICB) has been proposed as a promising analgesia technique.

Methods Data from 86 patients scheduled for PLTHA with spinal anesthesia were analyzed in this prospective randomized controlled trial. Patients were randomly divided into two groups of 43 patients each. As opposed to the control group (group C), ropivacaine group (group R) received additional SFICB using 40 mL of 0.375% ropivacaine. As primary endpoint, blind observers noted total morphine consumption at postoperative 48 hours. Secondary endpoints were pain at rest and mobilization on 0–10 Numeric Rating Scale (rest and dynamic NRS) at fixed time points (1 hour and 6 hours after surgery, and at day 1 and day 2 at 8:00, 13:00 and 18:00 hours), walking performance at day 1 and day 2; postoperative complications including morphine-related side effects or orthostatic intolerance symptoms such as dizziness, nausea, blurred vision or vasovagal syncope.

Results A 48-hour morphine consumption (mg; median (IQR)) was significantly lower in group R than in group C (11 (8.5–15.5)) vs 26 (21–33.5), p<0001), as well as incidence of morphine-related side effects such as nausea at day 1 (p=0.04) and day 2 (p<0.01). Rest and dynamic NRS were globally significantly lower in group R than in group C (p<0.01). Group R showed less orthostatic intolerance at day 1 (p<0.001) and day 2 (p<0.01) and better functional walking performance at day 1 (<0.001) and day 2 (<0.001).

Discussion In PLTHA, SFICB provides opioid sparing, improved postoperative pain control, and enhanced functional recovery.

Trial registration number NCT04574479.

  • Pain Management
  • Lower Extremity
  • Pain, Postoperative
  • Nerve Block
  • Analgesics, Opioid

Data availability statement

Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. Data are available upon request to the authors.

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Data availability statement

Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. Data are available upon request to the authors.

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Footnotes

  • Presented at Meetings where the work has been presented: Preliminary results of this study have been presented at the Graduation Day of the Belgian Society of Anesthesiology, Resuscitation, Perioperative medicine and Pain management held in Brussels on June 19, 2021. Abstract of preliminary results has also been presented in part at the annual congress of the European Society of Anesthesia and Intensive Care (ESAIC) on December 17, 2021–December 19, 2021 (online meeting).

  • Contributors MC: This author is responsible for the overall content as guarantor. MC accepted full responsibility for the finished work and the conduct of the study, had access to the data, and controlled the decision to publish. This author conceived the study, wrote the protocol, helped perform data acquisition and analysis, and wrote the manuscript. FB: This author helped in data acquisition and analysis, and reviewed the manuscript. NP: This author helped writing the protocol and conceiving the study, performed data acquisition and reviewed the manuscript. SD: This author helped writing the protocol, performed data acquisition and reviewed the manuscript. WK: This author helped writing the protocol, and reviewed the manuscript. J-PL: This author helped writing the protocol and conceiving the study, and reviewed the manuscript. VLB: This author helped conceiving the study and analyzing data, and reviewed the manuscript.

  • Funding This work was supported by the Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium.

  • Competing interests VLB has received funds and research support from Orion Pharma as well as honoraria from Medtronic. He is the Editor-in-Chief of the Acta Anaesthesiologica Belgica, and has a consultancy contract with Edwards Medical.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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