title: A Longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphine Consumption After Total Hip Arthroplasty.
abstract: OBJECTIVE
  The role of a fascia iliaca compartment block (FICB) for postoperative analgesia after total hip arthroplasty (THA) remains questionable. High-dose local anesthetics and a proximal injection site may be essential for successful analgesia. High-dose local anesthetics may pose a risk for local anesthetic systemic toxicity. We hypothesized that a high-dose longitudinal supra-inguinal FICB is safe and decreases postoperative morphine consumption after anterior approach THA.
  
  
  METHODS
  We conducted a prospective, double blind, randomized controlled trial. Patients scheduled for THA were randomized to group FICB (longitudinal supra-inguinal FICB with 40-mL ropivacaine 0.5%) or group C (control, no block). Standard hypothesis tests (t test or Mann-Whitney U test, χ test) were performed to analyze baseline characteristics and outcome parameters. The primary end point of the study was total morphine (mg) consumption at 24 hours postoperatively. Serial total and free ropivacaine serum levels were determined in 10 patients.
  
  
  RESULTS
  After obtaining ethical committee approval and written informed consent, 88 patients were included. Mean (SD) morphine consumption at 24 hours postoperatively was reduced in group FICB compared to group C: 10.25 (1.64) mg versus 19.0 (2.4) mg (P = 0.004). Using a mean dose of 2.6-mg/kg ropivacaine (range, 2-3.4 mg/kg), none of the patients had total or free ropivacaine levels above the maximum tolerated serum concentration.
  
  
  CONCLUSIONS
  We conclude that a high-dose longitudinal supra-inguinal FICB reduces postoperative morphine requirements after anterior approach THA.Clinical Trials Registry: EU Clinical Trials Register. www.clinicaltrialsregister.eu #2014-002122-12.
authors.affiliation: From the *Department of Anaesthesia, AZ Groeninge, Kortrijk, Belgium; †Department of Anaesthesia, AZ Turnhout, Turnhout, Belgium; ‡Department Cardiovascular Sciences, KU Leuven, Department of Anesthesiology, UZ Leuven, Leuven, Belgium; §Clinical Laboratory, AZ Groeninge, Kortrijk, Belgium; and ∥Department of Public Health and Primary Care, KU Leuven Campus Kulak, Kortrijk, Belgium.
authors.forename: Matthias
authors.initials: M
authors.lastname: Desmet
authors.forename: Kris
authors.initials: K
authors.lastname: Vermeylen
authors.forename: Imré
authors.initials: I
authors.lastname: Van Herreweghe
authors.forename: Laurence
authors.initials: L
authors.lastname: Carlier
authors.forename: Filiep
authors.initials: F
authors.lastname: Soetens
authors.forename: Stijn
authors.initials: S
authors.lastname: Lambrecht
authors.forename: Kathleen
authors.initials: K
authors.lastname: Croes
authors.forename: Hans
authors.initials: H
authors.lastname: Pottel
authors.forename: Marc
authors.initials: M
authors.lastname: Van de Velde
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000639:trends; D001340:Autonomic Nerve Block / Q000379:methods*; D004311:Double-Blind Method; D005205:Fascia; D005260:Female; D006801:Humans; D007085:Ilium; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine