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Opioid-free analgesia by continuous psoas compartment block after total hip arthroplasty. A randomized study1

Published online by Cambridge University Press:  01 May 2008

C. Becchi ,
M. Al Malyan ,
R. Coppini ,
M. Campolo ,
M. Magherini  and
S. Boncinelli
C. Becchi*
Affiliation:
Florence University, Department of Medical and Surgical Critical Care, Section of Anaesthesia and Intensive Care, Florence, Italy
M. Al Malyan
Affiliation:
Florence University, Department of Medical and Surgical Critical Care, Section of Anaesthesia and Intensive Care, Florence, Italy
R. Coppini
Affiliation:
CTO-AOUC, Anaesthesia and Intensive Care, Florence, Italy
M. Campolo
Affiliation:
CTO-AOUC, Anaesthesia and Intensive Care, Florence, Italy
M. Magherini
Affiliation:
CTO-AOUC, Anaesthesia and Intensive Care, Florence, Italy
S. Boncinelli
Affiliation:
Florence University, Department of Medical and Surgical Critical Care, Section of Anaesthesia and Intensive Care, Florence, Italy
*
Correspondence to: Chiara Becchi, Florence university – AOUC Careggi, V.le Morgagni 85, 50134 Florence, Italy. E-mail: [email protected]; Tel/Fax: +39 055 412862
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Summary

Background and objective

Adequate analgesia is needed after total hip arthroplasty to control pain at rest and during rehabilitation. Our aim was to compare, in a randomized study, the efficacy of two analgesia regimens in control of postoperative pain after total hip arthroplasty: opioid-free continuous psoas compartment block vs. an opioid/non-steroidal anti-inflammatory drugs continuous intravenous infusion.

Methods

In all, 73 patients (ASA I–III), aged 61–82 yr, undergoing total hip arthroplasty were prospectively enrolled in a single-blind randomized trial. Patients were allocated either to the study group (Group A, n = 37) or to the control group (Group B, n = 36). Patients in Group A underwent preoperative placement of a catheter in the psoas compartment and, 30 min before the end of surgery, the catheter was primed with a loading dose of 0.75% ropivacaine (0.4 mL kg−1) followed by a continuous infusion of 10 mL h−1 ropivacaine 0.2% for 48 h. Patients in Group B received, from 1 h before the end of surgery, a continuous intravenous infusion of 0.1% morphine and 0.12% ketorolac at 2 mL h−1 for 48 h. Both groups received spinal anaesthesia for surgery. Pain scores at rest and after mobilization, amount of rescue analgesia, nausea/vomiting and haemodynamic parameters were recorded.

Results

In Group A, median pain scores were very low during the whole study duration both at rest and during physiotherapy in comparison to Group B. Less rescue analgesia was needed and less nausea and vomiting was observed in Group A.

Conclusions

Opioid-free continuous psoas compartment block seems to be an appropriate and reliable technique in providing effective postoperative analgesia at rest and during physiotherapy after total hip arthroplasty when compared to intravenous morphine/ketorolac infusion.

Keywords

ANAESTHESIA CONDUCTION, psoas compartment block, lumbar plexus block, continuous nerve blockPAIN, postoperativeSURGERY ORTHOPAEDIC
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 5 , May 2008 , pp. 418 - 423
Copyright
Copyright © European Society of Anaesthesiology 2007

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Footnotes

1

Preliminary data of this work have been presented at SIAARTI (Società Italiana Anestesia, Analgesia, Rianimazione e Terapia Intensiva) meeting, 2004.

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