Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-25T05:30:56.769Z Has data issue: false hasContentIssue false
  • English
  • Français

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: chiarabecchi@hotmail.com; Tel/Fax: +39 055 412862
Get access

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1

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

References

1.Bonica, J. Postoperative pain. In: Bonica, J, ed. The Management of Pain, 2nd edn. Philadelphia: Lea & Febiger, 1990: 461–480.Google Scholar
2.Capdevila, X, Macaire, P, Dadure, C et al. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation. Anesth Analg 2002; 94: 1606–1613.Google Scholar
3.Singelyn, FJ, Gouverneur, JM. Postoperative analgesia after total hip arthroplasty: i.v. PCA with morphine, patient-controlled epidural analgesia, or continuous “3-in-1” block? A prospective evaluation by our acute pain service in more than 1,300 patients. J Clin Anesth 1999; 11: 550–554.Google Scholar
4.Wulf, H, Biscoping, J, Beland, B, Bachmann-Mennega, B, Motsch, J, Ropivacaine Hip Replacement Multicenter Study Group. Ropivacaine epidural anesthesia and analgesia versus general anesthesia and intravenous patient-controlled analgesia with morphine in the perioperative management of hip replacement. Anesth Analg 1999; 89: 111–116.CrossRefGoogle ScholarPubMed
5.Enneking, FK, Wedel, DJ. The art and science of peripheral nerve blocks. Anesth Analg 2000; 90: 1–2.Google Scholar
6.Awad, IT, Duggal, EM. Posterior lumbar plexus block: anatomy, approaches, and techniques. Reg Anesth Pain Med 2005; 30: 143–149.Google ScholarPubMed
7.Chudinov, A, Berkenstadt, H, Salai, M, Cahana, A, Perel, A. Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures. Reg Anesth Pain Med 1999; 24: 563–568.Google Scholar
8.Capdevila, X, Coimbra, C, Choquet, O. Approaches to the lumbar plexus: success, risks, and outcome. Reg Anesth Pain Med 2005; 30: 150–162.Google Scholar
9.World Medical Association. Ethical principles for medical research involving human subjects. Eur J Emerg Med 2001; 8: 221–224.CrossRefGoogle Scholar
10.Stevens, RD, Van Gessel, E, Flory, N, Fournier, R, Gamulin, Z. Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. Anesthesiology 2000; 93: 115–121.CrossRefGoogle ScholarPubMed
11.Biboulet, P, Morau, D, Aubas, P, Bringuier-Branchereau, S, Capdevila, X. Postoperative analgesia after THA: comparison of IV PCA with morphine and single injection of femoral nerve or psoas compartment block. A prospective, randomized, double-blind study. Reg Anesth Pain Med 2004; 29: 102–109.Google Scholar
12.Hevia-Sanchez, V, Bermejoj-Alvarez, MA, Hevia-Mendez, A, Fervienza, P, Franch, M, Diaz, ML. Bloqueo posterior del plexo lumbar para analgesia postoperatoria de artroplastias de cadera. Rev Esp Anestesiol Reanim 2002; 49: 507–511.Google Scholar
13.Souron, V, Delaunay, L, Schifrine, P. Intrathecal morphine provides better postoperative analgesia than psoas compartment block after primary hip arthroplasty. Can J Anesth 2003; 50 6: 574–579.Google Scholar
14.Türker, G, Uckunkaya, N, Yavascaoglu, B, Yilmazlar, A, Ozcelik, S. Comparison of the catheter-technique psoas compartment block and the epidural block for analgesia in partial hip replacement surgery. Acta Anaesthesiol Scand 2003; 47 1: 30–36.CrossRefGoogle ScholarPubMed
15.Tokat, O, Turker, YG, Uckunkaya, N, Ylmazlar, A. A clinical comparison of psoas compartment and inguinal paravascular blocks combined with sciatic nerve block. J Int Med Res 2002; 30: 161–167.Google Scholar
16.Dadure, C, Raux, O, Gaudard, P et al. Continuous psoas compartment blocks after major orthopedic surgery in children: a prospective computed tomographic scan and clinical studies. Anesth Analg 2004; 98: 623–628.Google Scholar
17.Kaloul, I, Guay, J, Cote, C, Halwagi, A, Varin, F. Ropivacaine plasma concentrations are similar during continuous lumbar plexus blockade using the anterior three-in-one and the posterior psoas compartment techniques. Can J Anaesth 2004; 51: 52–56.Google Scholar
18.Mannion, S, Hayes, I, Loughnane, F, Murphy, DB, Shorten, GD. Intravenous but not perineural clonidine prolongs postoperative analgesia after psoas compartment block with 0.5% levobupivacaine for hip fracture surgery. Anesth Analg 2005; 100 3: 873–878.CrossRefGoogle Scholar
19.Scott, DB, Lee, A, Fagan, D et al. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989; 69: 563–569.Google Scholar
20.Macaire, P, Gaertner, E, Choquet, O. Le bloc du plexus lombaire est-il dangereux? In: Évaluation et Traitement de la Douleur. SFAR 2002. Paris: Elsevier et SFAR Ed., 2002: 37–50.Google Scholar
21.Pham Dang, C, Beaumont, S, Floch, H, Bodin, J, Winer, A, Pinaud, M. Acute toxic accident following lumbar plexus block with bupivacaine. Ann Fr Anesth Reanim 2000; 19: 356–359.Google ScholarPubMed
22.Pousman, RM, Mansoor, Z, Sciard, D. Total spinal anesthetic after continuous posterior lumbar plexus block. Anesthesiology 2003; 98: 1281–1282.CrossRefGoogle ScholarPubMed
23.Litz, RJ, Vincent, O, Wiessner, D, Heller, AR. Misplacement of a psoas compartment catheter in the subarachnoid space. Reg Anesth Pain Med 2004; 29: 60–64.Google Scholar
24.Pham Dang, C, Kick, O, Collet, T, Gouin, F, Pinaud, M. Continuous peripheral nerve blocks with stimulating catheter. Reg Anesth Pain Med 2003; 28: 79–82.CrossRefGoogle Scholar
25.Aida, S, Takahashi, H, Shimoji, K. Renal subcapsular hematoma after lumbar plexus block. Anesthesiology 1996; 84: 452–455.Google Scholar
26.Birnbaum, K, Prescher, A, Hessler, S, Heller, KD. The sensory innervation of the hip joint: an anatomical study. Surg Radiol Anat 1997; 19: 371–375.CrossRefGoogle ScholarPubMed
27.Parkinson, SK, Mueller, JB, Little, WL, Boiley, SL. Extent of blockade with various approaches to the lumbar plexus. Anesth Analg 1989; 68: 243–248.CrossRefGoogle Scholar
28.Seeberger, MD, Urwyler, A. Paravascular lumbar plexus block: block extension after femoral nerve stimulation and injection of 20 vs. 40 ml mepivacaine 10 mg/ml. Acta Anesthesiol Scand 1995; 39: 769–773.Google Scholar