title: Comparison of Continuous Epidural Analgesia, Patient-Controlled Analgesia with Morphine, and Continuous Three-in-One Femoral Nerve Block on Postoperative Outcomes after Total Hip Arthroplasty.
abstract: BACKGROUND
  Postoperative pain relief can be achieved with various modalities. However, there are only few reports that have analyzed postoperative analgesic techniques in total hip arthroplasty patients. The aim of this retrospective study was to compare the postoperative outcomes of three different analgesic techniques after total hip arthroplasty.
  
  
  METHODS
  We retrospectively reviewed the influence of three analgesic techniques on postoperative rehabilitation after total hip arthroplasty in 90 patients divided into three groups (n = 30 patients per group). Postoperative analgesia consisted of continuous epidural analgesia (Epi group), patient-controlled analgesia with morphine (PCA group), or a continuous femoral nerve block (CFNB group). We measured the following parameters relating to postoperative outcome: visual analog scale scores, the use of supplemental analgesia, side effects, length of the hospital stay, plasma D-dimer levels, and the Harris hip score.
  
  
  RESULTS
  Each group had low pain scores with no significant differences between the groups. The PCA group had a lower frequency of supplemental analgesia use compared to the Epi and CFNB groups. Side effects (nausea/vomiting, inappetence) and day 7 D-dimer levels were significantly lower in the CFNB group (p < 0.05). There were no significant differences between the groups in terms of the length of the hospital stay or the Harris hip score.
  
  
  CONCLUSIONS
  Although there were no clinically significant differences in outcomes between the three groups, the CFNB provided good pain relief which was equal to that of the other analgesics with fewer side effects and lower D-dimer levels in hospitalized patients following total hip arthroplasty.
authors.affiliation: Department of Orthopaedic Surgery, Okayama Medical Center, Okayama, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Tetsunaga
authors.affiliation: Department of Orthopaedic Surgery, Okayama Medical Center, Okayama, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Orthopaedic Surgery, Okayama Medical Center, Okayama, Japan.
authors.forename: Naofumi
authors.initials: N
authors.lastname: Shiota
authors.affiliation: Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Tetsunaga
authors.affiliation: Department of Orthopaedic Surgery, Okayama Medical Center, Okayama, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Orthopaedic Surgery, Okayama Medical Center, Okayama, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Okazaki
authors.affiliation: Department of Orthopaedic Surgery, Okayama Medical Center, Okayama, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yamada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D005267:Femoral Nerve; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009407:Nerve Block / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D009020:Morphine
keywords: Epidural anesthesia; Morphine; Nerve block; Total hip arthroplasty