Effectiveness of Fascia Iliaca Compartment Block after Elective Total Hip Replacement: A Prospective, Randomized, Controlled Study

Wojciech Gola, Szymon Bialka, Aleksander J Owczarek, Hanna Misiolek, Wojciech Gola, Szymon Bialka, Aleksander J Owczarek, Hanna Misiolek

Abstract

Objective: An assessment of the feasibility of fascia iliaca compartment block (FICB) combined with nonopioid analgesics and patient controlled analgesia (PCA), oxycodone, in the perioperative anaesthetic management for elective total hip replacement (THR).

Design: A randomised, single-center, open-label study.

Setting: A single hospital. The study was conducted from October 2018 to May 2019.

Participants: In total, 109 patients were scheduled for elective total hip replacement.

Interventions: Postoperative FICB with 0.375% ropivacaine in conjunction with nonopioid analgesics (paracetamol, metamizole, and pregabalin) and oxycodone as rescue analgesia.

Measurements: Pain intensity was measured using the Numeric Pain Rating Scale (NRS) at rest and during rehabilitation, the total dose of postoperative oxycodone required, the occurrence of opioid-related adverse events, patient hospitalisation time, and level of satisfaction. Follow-up period: 48 h.

Main results: A total of 109 patients were randomised into two groups and, of these, 9 were subsequently excluded from the analysis (three conversions to general anaesthesia, two failures to perform FICB, four failures to use the PCA pump). Patients in the FICB group received standard intravenous analgesia with FICB, and those in the control group were managed with standard intravenous analgesia only. Pain level measured with NRS was significantly lower at rest and during rehabilitation in the FICB group. Oxycodone use in the first 48 h was significantly higher in the control group (p < 0.001); additionally, the time to the first dose of rescue analgesia was significantly shorter (p < 0.001). In the control group, there was a higher rate of side effects and a significantly longer hospitalisation time (p < 0.001). Similarly, higher satisfaction with the applied analgesic treatment was noted in the FICB group.

Conclusions: FICB in elective THR treatments is an effective form of analgesia, which reduces the need for opioids, the number of complications, the length of hospitalisation, and which ensures a high level of patient satisfaction with the analgesic treatment used.

Trial registration: ClinicalTrials.gov No. NCT04690647.

Keywords: fascia iliaca compartment block; multimodal analgesia; regional anesthesia; total hip replacement.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Participant flow diagram.
Figure 2
Figure 2
Box-plot of resting NRS in the control and FICB group. Significantly lower resting NRS scores were found in the FICB group at all time points except for 48 h.
Figure 3
Figure 3
Box-plot of NRS in the control and FICB group during rehabilitation. Pain intensity was significantly lower in the FICB group during rehabilitation on day 1 and 2 postoperatively.
Figure 4
Figure 4
Box plot of oxycodone AUC in the control and FICB group.
Figure 5
Figure 5
The median oxycodone levels over time of the study groups (distance-weighted least squares smoothing).
Figure 6
Figure 6
Time to the first analgesic intervention. Significantly longer time to the first analgesic intervention in the FICB group compared to controls.

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