Analgesic effects of continuous fascia iliaca compartment blockversuscontinuous epidural analgesia after total hip arthroplasty

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Abstract

BACKGROUND:

Epidural analgesia has been considered a gold standard for postoperative analgesia in the lower limbs. Its outcomes are accurate and adverse reactions are few, so it can be used in the clinic. However, this method has adverse reactions such as hypotension and urine retention. Low molecular weight heparin should be used after operation, which can increase the possibility of epidural hematoma, and limits its application to epidural analgesia in the clinic. At present, few studies concerned ultrasound guided continuous fascia iliaca compartment block technology.

OBJECTIVE:

To evaluate the efficacy of postoperative pain relief and the joint rehabilitation between a continuous fascia iliaca compartment block and a continuous epidural analgesia for patients undergoing total hip arthroplasty.

METHODS:

A total of 60 patients undergoing a selective total hip arthroplasty were assigned to continuous fascia iliaca compartment block group and continuous epidural analgesia group (n=30). All patients in both groups received a pre-fluence before general anesthesia. Continuous fascia iliaca compartment block group were injected with 0.25% ropivacaine 30 mL via iliac fascia gap. Continuous epidural analgesia group received 0.20% ropivacaine 10 mL via epidural catheter, indwelling catheter. When the analgesic effect was identified, anesthesia intubation was carried out. After operation, medicine was given via iliac fascia and epidural analgesia pump in both groups respectively. Postoperative analgesia in single dose was not given. If pain could not be endured, analgesia would be rescued (parecoxib 20-40 mg/time) according to pain degree. Visual analogue scale scores, supplemental analgesia of parecoxib, complication of anesthesia, Harris hip joint scores, day of first walk, and duration of hospital stay were recorded.

RESULTS AND CONCLUSION:

No significant difference in visual analogue scale scores, supplemental analgesia, Harris hip joint scores and duration of hospital stay was detected. Day of first walk was earlier in the continuous fascia iliaca compartment block group than in the continuous epidural analgesia group. The complications were apparently lower in the continuous fascia iliaca compartment block group than in the continuous epidural analgesia group. These data indicated that after total hip arthroplasty, two kinds of analgesia methods could provide satisfactory postoperative outcomes. Hip joint was perfectly recovered. However, the complications of continuous fascia iliaca compartment block were less, and helpful to patients' early off-bed activities, and could be considered as a good choice for analgesia after total hip arthroplasty.

RESULTS AND CONCLUSION:

Subject headings: prostheses and implants; arthroplasty, replacement, hip; analgesia, epidural

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