Postoperative analgesia after total-hip arthroplasty: Comparison of intravenous patient-controlled analgesia with morphine and single injection of femoral nerve or psoas compartment block. a prospective, randomized, double-blind study.
BACKGROUND
The authors compared the analgesic effects and quality of rehabilitation of three analgesic techniques after total-hip arthroplasty in a double-blind, randomized trial.


METHODS
Forty-five patients were assigned to 1 of 3 groups, patient-controlled analgesia with morphine (PCA), femoral nerve block (FNB), or psoas compartment block (PCB). At the end of the procedure performed under general anesthesia, nerve blocks using 2 mg/kg of 0.375% bupivacaine and 2 microg/kg of clonidine were performed in the FNB (n = 16) and PCB (n = 15) groups. In the recovery room, all 3 groups received initial intravenous morphine titration if their pain score was higher than 30 on a 100-mm visual analog scale (VAS), and then a PCA device was initiated. Morphine consumption was the primary end point to assess postoperative analgesia.


RESULTS
After extubation (H0), morphine titration was higher in the PCA group (P <.05). During the first 4 postoperative hours (H0 to H4), morphine consumption per hour and VAS pain score were lower in the PCB group (P <.05). After H4, there was no difference in morphine consumption and VAS among groups, either at rest or during mobilization. After H4, morphine consumption remained lower than 0.5 mg/h, and VAS remained lower than 30 mm in the 3 groups. In 4 patients of the PCB group, an epidural diffusion was noted. Hip mobility and length of stay in the rehabilitation center were not different among the groups.


CONCLUSIONS
PCA is an efficient and safe analgesia technique. FNB and PCB should not be used routinely after total-hip arthroplasty.
Biboulet
Philippe
P
Department of Anesthesiology and Critical Care, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France. p-biboulet@chu-montpellier.fr
Morau
Didier
D
Aubas
Pierre
P
Bringuier-Branchereau
Sophie
S
Capdevila
Xavier
X
D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation; D002045:Bupivacaine / Q000008:administration & dosage; D003000:Clonidine / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005267:Femoral Nerve; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D016658:Psoas Muscles / Q000294:innervation*
D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D003000:Clonidine; D002045:Bupivacaine