title: An ultrasound-guided fascia iliaca catheter technique does not impair ambulatory ability within a clinical pathway for total hip arthroplasty.
abstract: BACKGROUND
  Both neuraxial and peripheral regional analgesic techniques offer postoperative analgesia for total hip arthroplasty (THA) patients. While no single technique is preferred, quadriceps muscle weakness from peripheral nerve blocks may impede rehabilitation. We designed this study to compare postoperative ambulation outcome in THA patients who were treated with a new ultrasound-guided fascia iliaca catheter (FIC) technique or intrathecal morphine (ITM).
  
  
  METHODS
  We reviewed the electronic health records of a sequential series of primary unilateral THA patients who were part of a standardized clinical pathway; apart from differences in regional analgesic technique, all other aspects of the pathway were the same. Our primary outcome was total ambulation distance (meters) combined for postoperative days 1 and 2. Secondary outcomes included daily opioid consumption (morphine milligram equivalents) and analgesic-related side effects. We examined the association between the primary outcome and analgesic technique by performing crude and adjusted ordinary least-squares linear regression. A P value < 0.05 was considered statistically-significant.
  
  
  RESULTS
  The study analyzed the records of 179 patients (fascia iliaca, n = 106; intrathecal, n = 73). The primary outcome (total ambulation distance) did not differ between the groups (P = 0.08). Body mass index (BMI) was the only factor (β = -1.7 [95% CI -0.5 to -2.9], P < 0.01) associated with ambulation distance. Opioid consumption did not differ, while increased pruritus was seen in the intrathecal group (P < 0.01).
  
  
  CONCLUSIONS
  BMI affects postoperative ambulation outcome after hip arthroplasty, whereas the type of regional analgesic technique used does not. An ultrasound-guided FIC technique offers similar analgesia with fewer side effects when compared with ITM.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: Seshadri C
authors.initials: SC
authors.lastname: Mudumbai
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: T Edward
authors.initials: TE
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Howard
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA.; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Giori
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA.; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Woolson
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Toni
authors.initials: T
authors.lastname: Ganaway
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Kou
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: King
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: Edward R
authors.identifier: 0000-0003-2735-248X
authors.initials: ER
authors.lastname: Mariano
keywords: Hip arthroplasty; Hip replacement; Nerve block; Regional anesthesia; Spinal anesthesia; Ultrasonography