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Jessen C, Espelund US, Brix LD, Nielsen TD, Lund B, Bendtsen TF. Subpectineal obturator nerve block reduces opioid consumption after hip arthroscopy: a triple-blind, randomized, placebo-controlled trial. Reg Anesth Pain Med 2024:rapm-2024-105638. [PMID: 38925710 DOI: 10.1136/rapm-2024-105638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Hip arthroscopy causes severe pain during the first few hours in the postoperative care unit. This is probably due to the intraoperative stretching of the hip joint capsule. Pain relief requires high doses of opioids which may prolong recovery and may cause opioid-related adverse events.The majority of hip joint capsule nociceptors are located anteriorly. The obturator nerve innervates the anteromedial part of the hip joint capsule. We hypothesized that a subpectineal obturator nerve block using 15 ml bupivacaine 5 mg/mL with added epinephrine 5 μg/mL would reduce the opioid consumption after hip arthroscopy. METHODS 40 ambulatory hip arthroscopy patients were enrolled in this randomized, triple-blind controlled trial. All patients were allocated to a preoperative active or placebo subpectineal obturator nerve block. The primary outcome was opioid consumption for the first 3 hours in the postanesthesia care unit. Secondary outcomes were pain, nausea, and hip adductor strength. RESULTS 34 patients were analyzed for the primary outcome. The mean intravenous morphine equivalent consumption in the subpectineal obturator nerve block group was 11.9 mg vs 19.7 mg in the placebo group (p<0.001). The hip adductor strength was significantly reduced in the active group. No other intergroup differences were observed regarding the secondary outcomes. CONCLUSION We found a significant reduction in the opioid consumption for patients receiving an active subpectineal obturator nerve block. The postoperative intravenous morphine equivalent reduction the first painful 3 hours was reduced by 40% for patients receiving a subpectineal obturator nerve block in this randomized, triple-blind trial. TRIAL REGISTRATION NUMBER EudraCT database 2021-006575-42.
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Affiliation(s)
- Christian Jessen
- Department of Anesthesiology and Intensive Care, PeriSCOP, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University Faculty of Health, Aarhus, Denmark
| | - Ulrick Skipper Espelund
- Department of Anesthesiology and Intensive Care, PeriSCOP, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University Faculty of Health, Aarhus, Denmark
| | - Lone Dragnes Brix
- Department of Anesthesiology and Intensive Care, PeriSCOP, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University Faculty of Health, Aarhus, Denmark
| | - Thomas Dahl Nielsen
- Department of Clinical Medicine, Aarhus University Faculty of Health, Aarhus, Denmark
| | - Bent Lund
- Department of Clinical Medicine, Aarhus University Faculty of Health, Aarhus, Denmark
- Department of Orthopedic Surgery, H-Hip, Horsens Regional Hospital, Horsens, Denmark
| | - Thomas Fichtner Bendtsen
- Department of Clinical Medicine, Aarhus University Faculty of Health, Aarhus, Denmark
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
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Wang CG, Zhang ZQ, Yang Y, Long YB, Wang XL, Ding YL. A randomized controlled trial of iliopsoas plane block vs. femoral nerve block for hip arthroplasty. BMC Anesthesiol 2023; 23:197. [PMID: 37291487 PMCID: PMC10249315 DOI: 10.1186/s12871-023-02162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Iliopsoas plane block (IPB) is a novel analgesic technique for hip surgery that retains quadriceps strength. However, evidence from randomized controlled trial is remains unavailable. We hypothesized that IPB, as a motor-sparing analgesic technique, could match the femoral nerve block (FNB) in pain management and morphine consumption, providing an advantage for earlier functional training in patients underwent hip arthroplasty. METHODS We recruited ninety patients with femoral neck fracture, femoral head necrosis or hip osteoarthritis who were scheduled for unilateral primary hip arthroplasty were recruited and received either IPB or FNB. Primary outcome was the pain score during hip flexion at 4 h after surgery. Secondary outcomes included quadriceps strength and pain scores upon arrival at post anesthesia care unit (PACU) and at 2, 4, 6, 24, 48 h after surgery, the first time out of bed, total opioids consumption, patient satisfaction, and complications. RESULTS There was no significant difference in terms of pain score during hip flexion at 4 h after surgery between the IPB group and FNB group. The quadriceps strength of patients receiving IPB was superior to those receiving FNB upon arrival at PACU and at 2, 4, 6 and 24 h after surgery. The IPB group showed a shorter first time out of bed compared to the FNB group. However, there were no significant differences in terms of pain scores within 48 h after surgery, total opioids consumption, patient satisfaction and complications between the two groups. CONCLUSION IPB was not superior to FNB in terms of postoperative analgesia for hip arthroplasty. However, IPB could serve as an effective motor-sparing analgesic technique for hip arthroplasty, which would facilitate early recovery and rehabilitation. This makes IPB worth considering as an alternative to FNB. TRIAL REGISTRATION The trial was registered prior to patient enrollment at the Chinese Clinical Trial Registry (ChiCTR2200055493; registration date: January 10, 2022; enrollment date: January 18, 2022; https://www.chictr.org.cn/searchprojEN.html ).
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Affiliation(s)
- Chun-Guang Wang
- Department of Anesthesiology, The First Central Hospital of Baoding, Northern Great Wall Street 320#, Baoding, 071000, Hebei, China.
| | - Zhi-Qiang Zhang
- Department of Cardio-Thoracic Surgery, The First Central Hospital of Baoding, Baoding, 071000, China
| | - Yang Yang
- Department of Anesthesiology, The First Central Hospital of Baoding, Northern Great Wall Street 320#, Baoding, 071000, Hebei, China
| | - Yu-Bin Long
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, Hebei, China
| | - Xiu-Li Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Yan-Ling Ding
- Department of Anesthesiology, The First Central Hospital of Baoding, Northern Great Wall Street 320#, Baoding, 071000, Hebei, China
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Wang CG, Yang Y, Yang MY, Wang XL, Ding YL. Analgesic effect of iliopsoas plane block for hip fracture. Perioper Med (Lond) 2022; 11:15. [PMID: 35418144 PMCID: PMC9008941 DOI: 10.1186/s13741-022-00254-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background Hip fracture and surgery are associated with moderate to severe pain, which hampers early mobilization and extends the hospital stay. Femoral nerve block and fascia iliaca compartment block could provide effective postoperative pain relief. Unfortunately, they could weaken the strength of the quadriceps muscle and increase the risk of falls. Iliopsoas plane block (IPB) is a novel motor-sparing regional technique, which targets the sensory branches of the hip joint originating from the femoral nerve. However, the analgesic effect of IPB has not been confirmed yet. Case presentation In the present case series, IPB and lateral femoral cutaneous nerve block were implemented under the guidance of ultrasound for eight patients with hip fractures. The median (IQR) visual analog scale (VAS) score (0–10; 0: no pain, 10: worst pain) decreased from 1.5 (0.25–2) before IPB to 0 (0–0) 0.5h after IPB at rest. The median (IQR) VAS score decreased from 8 (7–8) before IPB to 2 (1–2) 0.5h after IPB during flexion of hip 30°. Pain score was no more than one at rest and three during flexion of the hip 30° within 48h after surgery. Furthermore, the MMT grades of quadriceps strength were no less than four after IPB. Conclusions Our case series firstly highlights that IPB might be an effective analgesic technique for hip fracture and surgery, while retaining motor function.
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Affiliation(s)
- Chun-Guang Wang
- Department of Anesthesiology, The First Central Hospital of Baoding, Northern Great wall Street 320#, Baoding, 071000, Hebei, China.
| | - Yang Yang
- Department of Anesthesiology, The First Central Hospital of Baoding, Northern Great wall Street 320#, Baoding, 071000, Hebei, China
| | - Ming-Yu Yang
- Department of Anesthesiology, The First Central Hospital of Baoding, Northern Great wall Street 320#, Baoding, 071000, Hebei, China
| | - Xiu-Li Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Yan-Ling Ding
- Department of Anesthesiology, The First Central Hospital of Baoding, Northern Great wall Street 320#, Baoding, 071000, Hebei, China
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Chen L, Shen Y, Liu S, Cao Y, Zhu Z. Ultrasound-guided supra-inguinal fascia Iliaca compartment block for older adults admitted to the emergency department with hip fracture: a randomized controlled, double-blind clinical trial. BMC Geriatr 2021; 21:669. [PMID: 34852764 PMCID: PMC8638559 DOI: 10.1186/s12877-021-02646-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Hip fracture is common in older adults, and can cause severe post-fracture pain. Fascia iliaca nerve block has consequently been used for preoperative analgesia. Methods We performed a randomized, controlled, double-blind clinical trial and recruited older patients with hip fractures. These patients were randomized into two groups and received ultrasound-guided fascia iliaca compartment block using either the supra-inguinal approach (group F) or the classical approach (group C). Heart rate, blood pressure, and resting and exercising visual analog scales were recorded before the procedure and at 30 min, and 6, 12, and 24 h after completion of the procedure. We recorded the duration of the procedure—as well as complications such as bleeding, hypotension, and intractable vomiting; the sleep duration in a 24 h period was also documented. Results A total of 38 patients completed the trial, and we observed no differences in the baseline characteristics or pre-procedural measurements between the two groups. Compared with the patients in group C, patients in group F exhibited significantly lower exercising VAS scores at 6 and 12 h after the procedure, faster heart rates at 6 and 24 h after the procedure, a longer procedural duration, and a longer sleep duration. There were no differences in the frequencies of complications between the two groups. The percentages of patients who took oral analgesics and the numbers of medications consumed were also not different between the two groups. Conclusions The supra-inguinal FICB provided effective analgesia and improved exercise tolerance compared with the classical approach. Trial registration The trial was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2100045644, registration date: 2021 April 20).
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Affiliation(s)
- Liang Chen
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yang Shen
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China.
| | - Shuangmei Liu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yanyan Cao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhe Zhu
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China
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Marty P, Chassery C, Rontes O, Vuillaume C, Basset B, Merouani M, Marquis C, Delussy A, Delbos MC, Ferre F, Bataille B, Joshi G, Delbos A. Obturator nerve block does not provide analgesic benefits in total hip arthroplasty under multimodal analgesic regimen: a randomized controlled trial. Reg Anesth Pain Med 2021; 46:657-662. [PMID: 33952684 DOI: 10.1136/rapm-2021-102531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES Although regional analgesia is considered an important component of optimal pain management, use of peripheral nerve blocks for total hip arthroplasty remains controversial. Since the obturator nerve innervates the anteromedial part of the joint capsule, we hypothesized that an obturator nerve block would decrease the opioid consumption after total hip arthroplasty. METHODS In this single center, prospective, triple blinded study, we randomly allocated 60 patients undergoing total hip arthroplasty under opioid-sparing total intravenous general anesthesia to a preoperative obturator nerve block or a sham block (placebo group) using 20 mL of ropivacaine 0.2% or saline, respectively. All patients received a multimodal analgesic regimen with non-opioid analgesics including periarticular local infiltration analgesia. The primary outcome was the intravenous opioid consumption in the post-anesthesia care unit. RESULTS Median (IQR) intravenous oxycodone consumption in the post-anesthesia care unit was 4 (2, 7.5) mg in the obturator nerve block group and 3 (0, 4) mg in the placebo group (p=0.05). There were no differences in pain scores between groups in the first 24 hours except at arrival on the surgical ward with significant higher pain scores in the placebo group (p=0.03). The ability to stand up and walk within 24 hours was comparable between groups as was the time to first walk (180 (90, 720) vs 240 (120, 780) min for the obturator nerve block and placebo groups, respectively; p=0.62). CONCLUSIONS Obturator nerve block did not improve postoperative opioid consumption after total hip arthroplasty performed under general anesthesia with a multimodal analgesic regimen. TRIAL REGISTRATION NUMBER NCT04085640.
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Affiliation(s)
- Philippe Marty
- Department of Anesthesia, Clinique Medipole Garonne, Toulouse, Occitanie, France
| | - Clement Chassery
- Department of Anesthesia, Clinique Medipole Garonne, Toulouse, Occitanie, France
| | - Olivier Rontes
- Department of Anesthesia, Clinique Medipole Garonne, Toulouse, Occitanie, France
| | - Corine Vuillaume
- Department of Anesthesia, Clinique Medipole Garonne, Toulouse, Occitanie, France
| | - Bertrand Basset
- Department of Anesthesia, Clinique Medipole Garonne, Toulouse, Occitanie, France
| | - Mehdi Merouani
- Department of Anesthesia, Clinique Medipole Garonne, Toulouse, Occitanie, France
| | - Constance Marquis
- Department of Anesthesia, Clinique Medipole Garonne, Toulouse, Occitanie, France
| | - Anne Delussy
- Department of Anesthesia, Clinique Medipole Garonne, Toulouse, Occitanie, France
| | - Marie-Claude Delbos
- Department of Anesthesia, Clinique Medipole Garonne, Toulouse, Occitanie, France
| | - Fabrice Ferre
- Department of Anesthesia, Hôpital Purpan, Toulouse, Midi-Pyrénées, France
| | - Benoit Bataille
- Department of Anesthesia and Intensive Care, Narbonne Hospital Orthopedic and Trauma Surgery, Narbonne, Occitanie, France
| | - Girish Joshi
- Department of Anesthesiology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Alain Delbos
- Department of Anesthesia, Clinique Medipole Garonne, Toulouse, Occitanie, France
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Yamada K, Inomata S, Saito S. Minimum effective volume of ropivacaine for ultrasound-guided supra-inguinal fascia iliaca compartment block. Sci Rep 2020; 10:21859. [PMID: 33318589 PMCID: PMC7736848 DOI: 10.1038/s41598-020-79059-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022] Open
Abstract
Supra inguinal fascia iliaca compartment block (FICB) is increasingly used in elderly patients with hip fractures. However, the minimum effective volume of local anesthetics required for ultrasound-guided supra-inguinal FICB has not been determined. With ethical committee approval and written informed consent from patients, we studied 21 consecutive patients of ASA physical status I–III undergoing surgery for hip fracture who met the inclusion criteria. Blocks were performed before going to the operation room. We determined the injection volumes of 0.25% ropivacaine for consecutive patients from the preceding patient's outcome. The initial volume was 30 ml. The testing interval was set at 10 ml, and the lowest volume was 5 ml. An effective block was defined as loss of sensation of pinprick in the territory of the femoral nerve and lateral cutaneous nerve of the thigh 30 min after the injection. The aim of this study was to determine the 50% effective volume (EV50) and the 95% effective volume (EV95) of 0.25% ropivacaine for ultrasound-guided supra-inguinal FICB using Logistic regression analysis. EV50 and EV95 of 0.25% ropivacaine for ultrasound-guided supra-inguinal FICB calculated with logistic regression analysis were 15.01 ml (95% confidence interval, 6.53–22.99 ml) and 26.99 ml (95% confidence interval, 20.54–84.09 ml), respectively. EV50 and EV95 of 0.25% ropivacaine for ultrasound-guided supra-inguinal FICB were 15.01 ml and 26.99 ml, respectively. Clinical trial number: UMIN000027277 (URL https://www.umin.ac.jp/ctr/index-j.htm).
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Affiliation(s)
- Kumiko Yamada
- Department of Anesthesiology, Tsukuba Gakuen Hospital, Tsukuba, Japan.
| | - Shinichi Inomata
- Division of Clinical Medicine, Department of Anesthesiology, Faculty of Medicine, University of Tsukuba, University of Tsukuba Hospital, Tsukuba, Japan
| | - Shigeyuki Saito
- Department of Anesthesiology, Tsukuba Gakuen Hospital, Tsukuba, Japan
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Nielsen ND. Peripheral nerve blocks for analgesia after elective total hip arthroplasty. Acta Anaesthesiol Scand 2020; 64:829-830. [PMID: 32078152 DOI: 10.1111/aas.13567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/12/2020] [Indexed: 12/12/2022]
Abstract
A significant subgroup of patients suffer from moderate or severe pain after total hip arthroplasty (THA). Regional analgesia has the potential to reduce post-operative pain and thereby spare patients from opioids, but regional analgesia of the hip is complicated as the area is innervated by multiple nerves. However, the nociceptors of the hip joint are primarily innervated by the obturator and femoral nerves. The effect of an obturator nerve block (ONB) on pain following THA has never been investigated. A femoral nerve block is known to reduce pain after THA, but is unfortunately accompanied by an increased risk of fall. We have developed a novel nerve block-the iliopsoas plane block (IPB)-that has the potential to anaesthetize the hip articular sensory branches of the femoral nerve without causing motor blockade.
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Affiliation(s)
- Niels Dalsgaard Nielsen
- Department of Health Aarhus University Department of Anesthesiology Aarhus University Hospital Aarhus Denmark
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Li J, Tang S, Lam D, Hergrueter A, Dennis J, Liu H. Novel utilization of fascial layer blocks in hip and knee procedures. Best Pract Res Clin Anaesthesiol 2019; 33:539-551. [DOI: 10.1016/j.bpa.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022]
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