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[Evaluation of postoperative analgesia with continuous iliofascial nerve sheath block after total hip arthroplasty
E Pavy1, V Compère, V Fourdrinier
1Département d'anesthésie-réanimation et Samu, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
Objective:
To assess the analgesic efficiency of a continuous iliofascial nerve sheath block after total hip arthroplasty replacement (RPTH).
Study Design:
open and prospective pilot study.
Patients And Methods:
Before induction of general anaesthesia (GA), an iliofascial catheter was inserted (group KT, n = 11) or not (group NKT, n = 10). In the KT group, 30 ml of ropivacaïne 4,75 mg/ml (maximum dose) were injected, and 14 mg/h of ropivacaïne 2 mg/ml were infused during the first 48 postoperative hours. All patients underwent a standardized GA and a multimodal postoperative analgesia with a intravenous PCA morphine, paracetamol and tramadol during the first 48 hours. Postoperative pain assessment which was achieved using visual analogic scores (VAS) at rest (EVAr) and on movement (EVAm), total morphine consumption, and side effects were collected during the first 48 hours. Statistical analysis was performed using a Mann and Whitney test for the quantitative values and a chi 2 exact test for the qualitative values. Data are expressed as median [interquartile range].
Results:
Total morphine consumption was lower in the KT group with a total amount of 26 mg [11-48] versus 77.5 mg [55-91] (p = 0.007) at h48. EVAr and EVAm were lower in the KT group at h4, h8, h24, h36 for the EVAr and during the 48 postoperative hours for EVAm. Three patients experienced nausea and/or vomiting in the KT group versus 6 in the NKT group (p = 0.05).
Conclusion:
After RPTH surgery, continuous iliofascial block reduces morphine consumption; provide a better pain relief at rest and on movement than IV multimodal analgesia alone.