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Fascia lliaca Block for Analgesia After Hip Arthroplasty: A Randomized Double-blind, Placebo-controlled Trial
  1. Ali N. Shariat, MD*,
  2. Admir Hadzic, MD, PhD†,
  3. Daquan Xu, MD†,
  4. Uma Shastri, MD†,
  5. Kwesi Kwofie, MD†,
  6. Kishor Gandhi, MD†,‡,
  7. Colleen Mitgang McCally, MD†,
  8. Kimberly Gratenstein, MD†,
  9. Catherine Vandepitte, MD†,§,
  10. Jeff Gadsden, MD† and
  11. Douglas Unis, MD∥
  1. *Department of Anesthesiology, St Luke’s–Roosevelt Hospital Center, and †Department of Anesthesiology, St Luke’s–Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY; ‡Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA; §Department of Anesthesiology Catholic University of Leuven, Leuven, Belgium; and ∥Department of Orthopedics, St Luke’s–Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY.
  1. Address correspondence to: Admir Hadzic, MD, PhD, Department of Anesthesiology, St Luke’s–Roosevelt Hospital Center, 1111 Amsterdam Ave, New York, NY 10025 (e-mail: admir{at}nysora.com).

Abstract

Background and Objectives Fascia iliaca block (FIB) is often used to treat pain after total hip arthroplasty (THA), despite a lack of randomized trials to evaluate its efficacy for this indication. The objective of this study was to assess the analgesic benefit of FIB after THA. Our primary hypothesis was administration of FIB decreases the intensity of postoperative pain (numeric rating scale [NRS-11] score) compared with sham block (SB) in patients after THA.

Methods After institutional review board approval and informed consent, 32 eligible patients having THA were recruited. In the postoperative care unit, although all patients received intravenous morphine sulfate patient-controlled analgesia, patients reporting pain of 3 or greater on the NRS-11 scale were randomized to receive ultrasound-guided fascia iliaca (30 mL 0.5% ropivacaine) or SB (30 mL 0.9% NaCl) using identical technique, below fascia iliaca. The primary outcome was pain intensity (NRS-11) after FIB.

Results Thirty-two patients (16 in each group) completed the study; all patients received an FIB. There was no difference in pain intensity (NRS-11 = 5.0 ± 0.6 vs 4.7 ± 0.6, respectively) after FIB versus SB or in opioid consumption (8.97 ± 1.6 vs 5.7 ± 1.6 mg morphine, respectively) between the groups at 1 hour. The morphine consumption after 24 hours was similar in both groups (49.0 ± 29.9 vs 50.4 ± 34.5 mg, P = 0.88, respectively).

Conclusions The evidence in these data suggests that the difference in average pain intensity after FIB versus SB was not significant (95% confidence interval, −2.2–1.4 NRS units).

https://doi.org/10.1097/AAP.0b013e31828a3c7c

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    Footnotes

    • The authors declare no conflict of interest.

      Support was provided solely from institutional and/or departmental sources: Department of Anesthesiology, St Luke’s–Roosevelt Hospital Center.

      The work has not been presented in any of the meetings.

      This trial has been registered at www.clinicaltrials.gov. There is no Clinical Trials.gov ID; however, protocol ID and date are 09-042 and 06/07/2012, respectively (Fascia Iliaca Compartment Block for Analgesia After Total Hip Arthroplasty [FICB]).