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.
OBJECTIVE
To assess the most appropriate postoperative analgesic technique after hip surgery.


METHODS
Prospective, nonrandomized study.


METHODS
University hospital.


METHODS
1,338 ASA physical status I, II, and III patients scheduled for elective unilateral total hip arthroplasty (THA).


METHODS
During the first 48 postoperative hours, pain relief was provided by intravenous (i.v.) patient-controlled analgesia (PCA) with morphine (Group 1), continuous "3-in-1" block (Group 2), or patient-controlled epidural analgesia (PCEA) (Group 3).


RESULTS
During a 7.5-year period, pain scores, supplemental analgesia, satisfaction score, technical problems, and side effects were collected by our acute pain service. Postoperative pain relief was comparable in the three groups. More paracetamol was required in Group 2 (1.0 +/- 1.2 g/48 h) and Group 3 (0.9 +/- 1.3 g/48 h) than in Group 1 (0.5 +/- 1.1 g/48 h) (p < 0.01). However, only 8% of patients in Group 2 and 12% of patients in Group 3 needed an opioid. A higher incidence of technical problems was noted in Group 3 (23.4%) than in Group 1 (2.3%) or Group 2 (5.5%) (p < 0.001). A lower incidence of side effects was observed in Group 2 (23.5%) when compared with Group 1 (58.8%) and Group 3 (71.9%) (p < 0.001). Satisfaction score was significantly higher in Group 2 than in the other two groups [80 +/- 16 vs. 87 +/- 14 vs. 81 +/- 14 in Groups 1, 2, and 3 respectively (p = 0.003)].


CONCLUSIONS
After THA, i.v. PCA with morphine, continuous "3-in-1" block, and PCEA provided comparable pain relief. Because it induces the fewest technical problems and side effects, continuous "3-in-1" block is the preferred technique.
Singelyn
F J
FJ
Department of Anesthesiology, Catholic University of Louvain School of Medicine, Brussels, Belgium. singelyn@anes.ucl.ac.be
Gouverneur
J M
JM
D000082:Acetaminophen / Q000627:therapeutic use; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D000700:Analgesics / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D002045:Bupivacaine / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009407:Nerve Block / Q000009:adverse effects; D018710:Pain Clinics; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D011446:Prospective Studies; D017409:Sufentanil / Q000627:therapeutic use
D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000082:Acetaminophen; D009020:Morphine; D008012:Lidocaine; D017409:Sufentanil; D002045:Bupivacaine