title: Comparison of Continuous Femoral Nerve Block, Caudal Epidural Block, and Intravenous Patient-controlled Analgesia in Pain Control After Total Hip Arthroplasty: A Prospective Randomized Study.
abstract: Thirty-six patients who underwent primary unilateral total hip arthroplasty (THA) were randomly allocated to 4 groups with different pain control protocols; continuous femoral nerve block (FNB group), single-shot caudal epidural block with morphine (EB group), intravenous patient-controlled analgesia with fentanyl (IV-PCA group), and systemic administration of nonsteroidal anti-inflammatory drugs (NSAIDs group). Postoperative pain was assessed using the numerical rating scale (NRS) scores and the analgesic effect was compared among the groups. The NRS upon arrival at the recovery room and 6 hours after surgery in the FNB, EB, and IV-PCA groups were significantly lower than that in the NSAIDs group. The amount of additional analgesics requested by the patient was smaller in the FNB, EB, and IV-PCA groups as compared to the NSAIDs group. Regarding the complications related to the analgesia, 5 of the 9 patients in the IV-PCA group complained nausea and vomiting and received antiemetic drugs. Delay in the rehabilitation process due to drowsiness was encountered in 3 patients in this group, while no patient in the FNB and EB groups suffered from delayed rehabilitation. Considering both the analgesic effect and the potential risk of complications, continuous femoral nerve blocks and caudal epidural blocks for are recommended for postoperative pain control after THA procedure.
authors.affiliation: Department of Orthopedic Surgery, Hyogo College of Medicine , Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Nishio
authors.affiliation: Department of Orthopedic Surgery, Hyogo College of Medicine , Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Fukunishi
authors.affiliation: Departments of Orthopedic Surgery and Anesthesia, Hyogo Prefectural Tsukaguchi Hospital , Japan.
authors.forename: Miura
authors.initials: M
authors.lastname: Juichi
authors.affiliation: Departments of Orthopedic Surgery and Anesthesia, Hyogo Prefectural Tsukaguchi Hospital , Japan.
authors.forename: Koyanagi
authors.initials: K
authors.lastname: Sahoko
authors.affiliation: Department of Orthopaedic Surgery, Iseikai Hospital, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fujihara
authors.affiliation: Department of Orthopaedic Surgery, Iseikai Hospital, Japan.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Fukui
authors.affiliation: Department of Orthopedic Surgery, Hyogo College of Medicine , Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yoshiya
keywords: block; pain; total hip arthroplasty
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