Effect of lateral femoral cutaneous nerve-block on pain after total hip arthroplasty: a randomised, blinded, placebo-controlled trial

Kasper H Thybo, Harald Schmidt, Daniel Hägi-Pedersen, Kasper H Thybo, Harald Schmidt, Daniel Hägi-Pedersen

Abstract

Background: Total hip arthroplasty (THA) is a common procedure associated with moderate postoperative pain. No nerve block without loss of motor function has been documented for THA. We hypothesised that an ultrasound-guided lateral femoral cutaneous nerve (LFCN) block added to a multimodal postoperative pain regimen would reduce postoperative pain after THA.

Methods: One hundred patients who had a THA by the posterior approach were evaluated in this randomised, placebo-controlled, blinded, parallel-group trial comparing an ultrasound-guided LFCN-block with either 8 ml of ropivacaine, 7.5 mg/ml, (Group Ropivacaine) or 8 ml of saline (Group Placebo) given postoperatively. Surgery was performed under spinal anaesthesia. The primary outcome was pain (measured on a Visual Analogue Scale (VAS)) 4 h post-blockade during 30° flexion of the hip. Secondary outcomes were pain at rest, pain during movement, oxycodone consumption (0-24 h), time to mobilisation, ability to mobilise, and length of stay. Patients, assessors and all staff involved with patient care were blinded to the intervention.

Results: There was no difference in primary outcome between Group Ropivacaine and Group Placebo (VAS 27 mm vs. 31 mm, p = 0.41; difference -5 mm (95% CI: -15 mm - +5 mm). No differences in any of the secondary outcomes were observed. No adverse events, or harms, were observed during the trial.

Conclusion: Pain scores, opioid use, time to mobilisation, and length of stay were low in both Group Ropivacaine and Group Placebo. We found no added analgesic effect of a LFCN-block when combined with paracetamol and ibuprofen after THA by the posterior approach.

Trial registration: EudraCT: 2013-004501-12 (December 16th 2013).

Keywords: Lateral femoral cutaneous nerve block; Peripheral nerve block; Postoperative analgesia; Total hip arthroplasty.

Figures

Fig. 1
Fig. 1
Ultrasound image of the lateral femoral cutaneous nerve. LFCN, Lateral Femoral Cutaneous Nerve
Fig. 2
Fig. 2
Flow-chart
Fig. 3
Fig. 3
Pain at rest. For T0, T1, T2, T4, and T24 there are 0, 9, 5, 4, and 16 % missing data respectively, equally distributed between groups. No differences were statistical significant. VAS, Visual Analogue Scale
Fig. 4
Fig. 4
Pain during movement. For T0, T1, T2, T4, and T24 there are 8, 18, 18, 14, and 28 % missing data respectively, equally distributed between groups. No differences were statistical significant. VAS, Visual Analogue Scale

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