title: The preoperative analgesic effect of 3-in-1 block on postoperative pain and tramadol consumption in total hip arthroplasty.
abstract: We studied the effect of preoperative 3-in-1 block for total hip replacement surgery on postoperative pain and tramadol consumption during patient-controlled analgesia. Thirty ASA I-II patients undergoing elective total hip arthroplasty (THA) were included in the study. Patients were randomly divided into 2 groups; Group I: Patients who received 3-in-1 block with 40 ml of 0.25% bupivacaine 30-minutes before surgery and later received general anesthesia, Group II: Patients who received only a simple needle puncture at the operation site 30-minutes before surgery and later received general anesthesia. All patients received intravenous tramadol at the end of surgery via a PCA device. Pain was evaluated at 0,1/2,1,4,8,12,24 and 48 h at rest and on movement of the hip, using a 10 cm VAS. The average intraoperative fentanyl consumption was lower in Group I than in Group II. VAS scores were significantly lower in group I, both at rest and during movement at all timepoints over in the first postoperative 12 h and also during movement 24 h postoperatively. However differences in VAS scores weren't clinically significant after 4 hours. In the recovery room, Group I VAS scores were only a third of Group II, both at rest and movement (p=0.0001). Total tramadol consumption was lower in Group I (633.0+/-119.3 mg) than in Group II (991.1+/-41.0 mg). Patient satisfaction scores were higher in Group I than in Group II. We concluded that preoperative 3-in-1 block with 40 ml-0,25% bupivacaine provides effective postoperative pain relief for elective THA, reducing intra-and postoperative analgesic consumption without increase in side effects.
authors.affiliation: Ministry of Health, Ankara Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey.
authors.forename: Süleyman
authors.initials: S
authors.lastname: Köroğlu
authors.forename: Suna Akin
authors.initials: SA
authors.lastname: Takmaz
authors.forename: Cetin
authors.initials: C
authors.lastname: Kaymak
authors.forename: Altuğ
authors.initials: A
authors.lastname: Narli
authors.forename: Kubilay
authors.initials: K
authors.lastname: Karalezli
authors.forename: Bayazit
authors.initials: B
authors.lastname: Dikmen
mesh_terms: D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002045:Bupivacaine / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006621:Hip Joint; D006801:Humans; D007262:Infusions, Intravenous; D007432:Intraoperative Period; D009068:Movement / Q000187:drug effects / Q000502:physiology; D009407:Nerve Block / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D017060:Patient Satisfaction; D011300:Preoperative Care; D014147:Tramadol / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D014147:Tramadol; D002045:Bupivacaine