Total hip arthroplasty as an overnight-stay procedure using an ambulatory continuous psoas compartment nerve block: a prospective feasibility study.
OBJECTIVE
Total hip arthroplasty (THA) results in severe postoperative pain requiring hospitalization to provide potent analgesia. Consequently, the average duration of hospitalization after THA in the United States is 4 to 5 days. This prospective study investigated the feasibility of converting THA into an overnight-stay procedure using a continuous psoas compartment nerve block provided at home with a portable infusion pump.


METHODS
Preoperatively, patients undergoing THA had a psoas compartment perineural catheter placed. Postoperatively, perineural ropivacaine 0.2% was delivered through postoperative day (POD) 4. Patients were discharged home when they met specific, prospectively defined criteria, as early as POD 3 for the first phase and POD 1 for the second phase. Of the patients in the first phase (n = 7) who remained hospitalized for at least 3 postoperative nights, 5 met discharge criteria on POD 1 and the remainder on POD 2. Of the patients in phase 2 (n = 5), all but 1 met discharge criteria on POD 1 and 3 were discharged directly home on POD 1. Postoperative pain was well controlled, opioid requirements and sleep disturbances were minimal, and patient satisfaction high.


CONCLUSIONS
These results suggest that for a subset of patients without major comorbidities, it is feasible to convert THA into an overnight-stay procedure using an ambulatory continuous psoas compartment nerve block as part of a multimodal analgesic regimen provided at home. Additional research is required to replicate these results in a controlled trial, define the appropriate subset of patients, and assess the incidence of complications associated with this practice before its mainstream use.
Department of Anesthesiology, University of Florida, Gainesville, FL 32610-0254, USA. bilfeld@ufl.edu
Brian M
BM
Ilfeld
Peter F
PF
Gearen
F Kayser
FK
Enneking
Linda F
LF
Berry
Eugene H
EH
Spadoni
Steven Z
SZ
George
Krista
K
Vandenborne
D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D010149:Postoperative Pain / Q000453:epidemiology* / Q000628:therapy; D011446:Prospective Studies; D016658:Psoas Muscles