An Obturator Nerve Block does not Alleviate Postoperative Pain after Total Hip Arthroplasty: a Randomized Clinical Trial

2019 ◽  
Vol 44 (4) ◽  
pp. 466-471 ◽  
Author(s):  
Niels Dalsgaard Nielsen ◽  
Charlotte Runge ◽  
Louise Clemmesen ◽  
Jens Børglum ◽  
Lone Ramer Mikkelsen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Nerve Block ◽  
Hip Arthroplasty ◽  
Obturator Nerve ◽  
Opioid Consumption ◽  
Secondary Outcome ◽  
Total Hip ◽  
Obturator Nerve Block ◽  
Adductor Muscles

Background and objectivesA substantial group of patients suffer from moderate to severe pain following elective total hip arthroplasty (THA). Due to the complex innervation of the hip, peripheral nerve block techniques can be challenging and are not widely used. Since the obturator nerve innervates both the anteromedial part of the joint capsule as well as intra-articular nociceptors, we hypothesized that an obturator nerve block (ONB) would decrease the opioid consumption after THA.MethodsSixty-two patients were randomized to receive ONB or placebo (PCB) after primary THA in spinal anesthesia. Primary outcome measure was opioid consumption during the first 12 postoperative hours. Secondary outcome measures included postoperative pain score, nausea score and ability to ambulate.ResultsSixty patients were included in the analysis. Mean (SD) opioid consumption during the first 12 postoperative hours was 39.9 (22.3) mg peroral morphine equivalents (PME) in the ONB group and 40.5 (30.5) mg PME in the PCB group (p=0.93). No difference in level of pain or nausea was found between the groups. Paralysis of the hip adductor muscles in the ONB group reduced the control of the operated lower extremity compared with the PCB group (p=0.026). This did, however, not affect the subjects’ ability to ambulate.ConclusionsA significant reduction in postoperative opioid consumption was not found for active versus PCB ONB after THA.Trial registration numberNCT03064165 and 2017-000068-14.

scholarly journals Participants with mild, moderate, or severe pain following total hip arthroplasty. A sub-study of the PANSAID trial on paracetamol and ibuprofen for postoperative pain treatment

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Luma Mahmoud Issa ◽  
Kasper Højgaard Thybo ◽  
Daniel Hägi-Pedersen ◽  
Jørn Wetterslev ◽  
Janus Christian Jakobsen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Severe Pain ◽  
Pain Treatment ◽  
Opioid Analgesic ◽  
Opioid Use ◽  
Mild Pain ◽  
Total Hip ◽  
Pain Scores

AbstractObjectivesIn this sub-study of the ‘Paracetamol and Ibuprofen in Combination’ (PANSAID) trial, in which participants were randomised to one of four different non-opioids analgesic regimen consisting of paracetamol, ibuprofen, or a combination of the two after planned primary total hip arthroplasty, our aims were to investigate the distribution of participants’ pain (mild, moderate or severe), integrate opioid use and pain to a single score (Silverman Integrated Approach (SIA)-score), and identify preoperative risk factors for severe pain.MethodsWe calculated the proportions of participants with mild (VAS 0–30 mm), moderate (VAS 31–60 mm) or severe (VAS 61–100 mm) pain and the SIA-scores (a sum of rank-based percentage differences from the mean rank in pain scores and opioid use, ranging from −200 to 200%). Using logistic regression with backwards elimination, we investigated the association between severe pain and easily obtainable preoperative patient characteristics.ResultsAmong 556 participants from the modified intention-to-treat population, 33% (95% CI: 26–42) (Group Paracetamol + Ibuprofen (PCM + IBU)), 28% (95% CI: 21–37) (Group Paracetamol (PCM)), 23% (95% CI: 17–31) (Group Ibuprofen (IBU)), and 19% (95% CI: 13–27) (Group Half Strength-Paracetamol + Ibuprofen (HS-PCM + IBU)) experienced mild pain 6 h postoperatively during mobilisation. Median SIA-scores during mobilisation were: Group PCM + IBU: −48% (IQR: −112 to 31), Group PCM: 40% (IQR: −31 to 97), Group IBU: −5% (IQR: −57 to 67), and Group HS-PCM + IBU: 6% (IQR: −70 to 74) (overall difference: p=0.0001). Use of analgesics before surgery was the only covariate associated with severe pain (non-opioid: OR 0.50, 95% CI: 0.29–0.82, weak opioid 0.56, 95% CI: 0.28–1.16, reference no analgesics before surgery, p=0.02).ConclusionsOnly one third of participants using paracetamol and ibuprofen experienced mild pain after total hip arthroplasty and even fewer experienced mild pain using each drug alone as basic non-opioid analgesic treatment. We were not able, in any clinically relevant way, to predict severe postoperative pain. A more extensive postoperative pain regimen than paracetamol, ibuprofen and opioids may be needed for a large proportion of patients having total hip arthroplasty. SIA-scores integrate pain scores and opioid use for the individual patient and may add valuable information in acute pain research.

scholarly journals Comparison of continuous femoral nerve block with and without combined sciatic nerve block after total hip arthroplasty: a prospective randomized study

2017 ◽  
Vol 9 (2) ◽  
Author(s):  
Shoji Nishio ◽  
Shigeo Fukunishi ◽  
Tomokazu Fukui ◽  
Yuki Fujihara ◽  
Shohei Okahisa ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Sciatic Nerve ◽  
Total Hip Arthroplasty ◽  
Nerve Block ◽  
Hip Arthroplasty ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Sciatic Nerve Block ◽  
Nerve Blockade ◽  
Continuous Femoral Nerve Block

In association with the growing interests in pain management, several modalities to control postoperative pain have been proposed and examined for the efficacy in the recent studies. Various modes of peripheral nerve block have been proposed and the effectiveness and safety have been examined for each of those techniques. We have described our clinical experiences, showing that continuous femoral nerve block could provide a satisfactory analgesic effect after total hip arthroplasty (THA) procedure. In this study, we compared the effectiveness and safety of continuous femoral nerve block with and without sciatic nerve blockade on pain control after THA. Forty patients scheduled for THA were included in the study and randomly divided into 2 groups. Postoperative analgesic measure was continuous femoral nerve block alone, while the identical regimen of continuous femoral nerve block was combined with sciatic nerve block. The amount of postoperative pain was evaluated in the immediate postoperative period, 6 hours, and 12 hours after surgery. Moreover, postoperative complications as well as requirement of supplemental analgesics during the initial 12 hours after surgery were reviewed in the patient record. The obtained study results showed that the supplemental sciatic nerve blockade provided no significant effect on arrival at the postoperative recovery room, while the NRS pain score was significantly reduced by the combined application of sciatic nerve blockade at 6 and 12 hours after surgery. In the investigation of postoperative analgesiarelated complications, no major complication was encountered without significant difference in complication rate between the groups.

Continuous Lumbar Plexus Block for Postoperative Pain Control After Total Hip Arthroplasty

2009 ◽  
Vol 91 (1) ◽  
pp. 29-37 ◽  
Author(s):  
Joseph Marino ◽  
Joseph Russo ◽  
Maureen Kenny ◽  
Robert Herenstein ◽  
Elayne Livote ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Pain Control ◽  
Lumbar Plexus ◽  
Postoperative Pain Control ◽  
Total Hip ◽  
Lumbar Plexus Block ◽  
Plexus Block

scholarly journals Obturator nerve block

2021 ◽  
Vol 14 (3) ◽  
pp. 130-140
Author(s):  
V. A. Koriachkin ◽  
D. V. Zabolotskii ◽  
D. V. Gribanov ◽  
T. A . Antoshkova
Keyword(s):  
Clinical Practice ◽  
Nerve Block ◽  
Lateral Wall ◽  
Obturator Nerve ◽  
Anatomical Landmarks ◽  
Anatomical Features ◽  
Obturator Nerve Block ◽  
Adductor Muscles ◽  
Ultrasonic Navigation ◽  
Hip And Knee Surgery

One of the forgotten techniques of regional anesthesia is blockade of the obturator nerve, which was performed using anatomical landmarks and neurostimulation. In recent years, ultrasonic navigation methods have gained wide popularity when using regional blockades. The purpose of the review is to present the current understanding of the use of obturator nerve block in clinical practice. The review presents the anatomical features of the obturator nerve passage, surgical and therapeutic indications for the use of its blockade. The technique for performing obturator blockade using ultrasound navigation is described in detail. Blockade of the obturator nerve using ultrasound navigation can reduce the likelihood of surgical complications during transurethral resection of a tumor located on the lateral wall of the bladder, improve analgesia after hip and knee surgery, and effectively relieve spastic conditions of the adductor muscles of the hip.

Continuous Posterior Lumbar Plexus Nerve Block Versus Periarticular Injection with Ropivacaine or Liposomal Bupivacaine for Total Hip Arthroplasty

2017 ◽  
Vol 99 (21) ◽  
pp. 1836-1845 ◽  
Author(s):  
Rebecca L. Johnson ◽  
Adam W. Amundson ◽  
Matthew P. Abdel ◽  
Hans P. Sviggum ◽  
Tad M. Mabry ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Nerve Block ◽  
Hip Arthroplasty ◽  
Lumbar Plexus ◽  
Liposomal Bupivacaine ◽  
Total Hip ◽  
Periarticular Injection

scholarly journals A Multidisciplinary Patient-Specific Opioid Prescribing and Tapering Protocol Is Associated with a Decrease in Total Opioid Dose Prescribed for Six Weeks After Total Hip Arthroplasty

Pain Medicine ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1474-1481 ◽  
Author(s):  
Mallika Tamboli ◽  
Edward R Mariano ◽  
Kerianne E Gustafson ◽  
Beverly L Briones ◽  
Oluwatobi O Hunter ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Opioid Consumption ◽  
Mean Difference ◽  
Patient Specific ◽  
Prescription Data ◽  
Opioid Dose ◽  
Total Hip ◽  
Institutional Review ◽  
Discharge Protocol

Abstract Objective This retrospective cohort study tested the hypothesis that implementing a multidisciplinary patient-specific discharge protocol for prescribing and tapering opioids after total hip arthroplasty (THA) will decrease the morphine milligram equivalent (MME) dose of opioids prescribed. Methods With institutional review board approval, we analyzed a Perioperative Surgical Home database and prescription data for all primary THA patients three months before (PRE) and three months after (POST) implementation of this new discharge opioid protocol based on patients’ prior 24-hour inpatient opioid consumption. The primary outcome was total opioid dosage in MME prescribed and opioid refills for six weeks after surgery. Secondary outcomes included the number of tablets and MME prescribed at discharge, in-hospital opioid consumption, length of stay, and postoperative complications. Results Forty-nine cases (25 PRE and 24 POST) were included. Total median (10th–90th percentiles) MME for six weeks postoperatively was 900 (57–2082) MME PRE vs 295 (69–741) MME POST (mean difference = 721, 95% confidence interval [CI] = 127–1316, P = 0.007, Mann-Whitney U test). Refill rates did not differ. The median (10th–90th percentiles) initial discharge prescription in MME was 675 (57–1035) PRE vs 180 (18–534) POST (mean difference = 387, 95% CI = 156–618, P = 0.003, Mann-Whitney U test) MME. There were no differences in other outcomes. Conclusions Implementation of a patient-specific prescribing and tapering protocol decreases the mean six-week dosage of opioid prescribed by 63% after THA without increasing the refill rate.

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