title: A randomised, controlled, double blind, non-inferiority trial of ultrasound-guided fascia iliaca block vs. spinal morphine for analgesia after primary hip arthroplasty.
abstract: We performed a single centre, double blind, randomised, controlled, non-inferiority study comparing ultrasound-guided fascia iliaca block with spinal morphine for the primary outcome of 24-h postoperative morphine consumption in patients undergoing primary total hip arthroplasty under spinal anaesthesia with levobupivacaine. One hundred and eight patients were randomly allocated to receive either ultrasound-guided fascia iliaca block with 2 mg.kg-1levobupivacaine (fascia iliaca group) or spinal morphine 100 μg plus a sham ultrasound-guided fascia iliaca block using saline (spinal morphine group). The pre-defined non-inferiority margin was a median difference between the groups of 10 mg in cumulative intravenous morphine use in the first 24 h postoperatively. Patients in the fascia iliaca group received 25 mg more intravenous morphine than patients in the spinal morphine group (95% CI 9.0-30.5 mg, p < 0.001). Ultrasound-guided fascia iliaca block was significantly worse than spinal morphine in the provision of analgesia in the first 24 h after total hip arthroplasty. No increase in side-effects was noted in the spinal morphine group but the study was not powered to investigate all secondary outcomes.
authors.affiliation: Glasgow Royal Infirmary Campus, School of Medicine, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
authors.forename: R
authors.initials: R
authors.lastname: Kearns
authors.affiliation: Department of Anaesthesia, Pain and Critical Care Medicine, Glasgow Royal Infirmary Infirmary and Stobhill Ambulatory Hospital, Glasgow, UK.
authors.forename: A
authors.initials: A
authors.lastname: Macfarlane
authors.affiliation: Department of Anaesthesia, Pain and Critical Care Medicine, Glasgow Royal Infirmary Infirmary and Stobhill Ambulatory Hospital, Glasgow, UK.
authors.forename: A
authors.initials: A
authors.lastname: Grant
authors.affiliation: Department of Anaesthesia, Pain and Critical Care Medicine, Glasgow Royal Infirmary Infirmary and Stobhill Ambulatory Hospital, Glasgow, UK.
authors.forename: K
authors.initials: K
authors.lastname: Puxty
authors.affiliation: Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: P
authors.initials: P
authors.lastname: Harrison
authors.affiliation: Glasgow Royal Infirmary Campus, School of Medicine, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
authors.forename: M
authors.initials: M
authors.lastname: Shaw
authors.affiliation: Department of Anesthesiology, Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Anderson
authors.affiliation: Glasgow Royal Infirmary Campus, School of Medicine, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
authors.forename: J
authors.initials: J
authors.lastname: Kinsella
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000775:Anesthesia, Spinal; D019644:Arthroplasty, Replacement, Hip; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D018084:Ultrasonography, Interventional
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: analgesia; fascia iliaca block; total hip replacement