Comparison of the catheter-technique psoas compartment block and the epidural block for analgesia in partial hip replacement surgery.
BACKGROUND
The aim of this study was to compare the intra- and postoperative analgesia provided by the catheter-technique psoas compartment block and the epidural block in hip-fractured patients. We also compared hemodynamic stability, motor blockade, ease of performing the technique, and complications.


METHODS
Thirty patients who underwent partial hip replacement surgery were included in this prospective single-blind study. Subjects were randomly assigned to Group E (n=15; general anesthesia plus epidural block with 15 ml of 0.5% bupivacaine) or Group P (n=15; general anesthesia plus psoas compartment block with 30 ml of 0.5% bupivacaine). Hemodynamic parameters were recorded at 10-min intervals intraoperatively. Regional anesthesia procedure time, number of attempts at block, intraoperative blood loss, and need for supplemental fentanyl and/or ephedrine were noted. Postoperatively, a patient-controlled analgesia device delivered an infusion and boluses of bupivacaine/fentanyl. Pain, motor blockade, ambulation time, patient satisfaction with analgesia, and complications were recorded postsurgery.


RESULTS
The epidural required significantly more attempts than the psoas block, thus procedure time was longer in this group. Group E also showed significantly greater drops in mean arterial blood pressure from baseline at 30, 40 and 50 min after the start of general anesthesia. Significantly more Group E patients required epinephrine supplementation. The groups were similar regarding pain scores (at rest and on movement) and patient satisfaction, but Group E had higher motor blockade scores, longer ambulation time, and significantly more complications.


CONCLUSIONS
The continuous psoas compartment block provides excellent intraoperative and postoperative analgesia with a low incidence of complications for partial hip replacement surgery
Türker
G
G
Department of Anesthesiology and Reanimation, Uludag University Medical Faculty, Bursa, Turkey. gturker@uludag.edu.tr
Uçkunkaya
N
N
Yavaşçaoğlu
B
B
Yilmazlar
A
A
Ozçelik
S
S
D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D016063:Blood Loss, Surgical; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D002404:Catheterization; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006439:Hemodynamics / Q000187:drug effects; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects; D019637:Orthopedic Procedures; D010149:Postoperative Pain / Q000188:drug therapy; D011446:Prospective Studies; D016658:Psoas Muscles; D016037:Single-Blind Method
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine