Combination Therapy with Continuous Three-in-One Femoral Nerve Block and Periarticular Multimodal Drug Infiltration after Total Hip Arthroplasty

Background. Various postoperative pain relief modalities, including continuous femoral nerve block (CFNB), local infiltration analgesia (LIA), and combination therapy, have been reported for total knee arthroplasty. However, no studies have compared CFNB with LIA for total hip arthroplasty (THA). The aim of this study was to compare the efficacy of CFNB versus LIA after THA. Methods. We retrospectively reviewed the postoperative outcomes of 93 THA patients (20 men, 73 women; mean age 69.2 years). Patients were divided into three groups according to postoperative analgesic technique: CFNB, LIA, or combined CFNB+LIA. We measured the following postoperative outcome parameters: visual analog scale (VAS) for pain at rest, supplemental analgesia, side effects, mobilization, length of hospital stay, and Harris Hip Score (HHS). Results. The CFNB+LIA group had significantly lower VAS pain scores than the CFNB and LIA groups on postoperative day 1. There were no significant differences among the three groups in use of supplemental analgesia, side effects, mobilization, length of hospital stay, or HHS at 3 months after THA. Conclusions. Although there were no clinically significant differences in outcomes among the three groups, combination therapy with CFNB and LIA provided better pain relief after THA than CFNB or LIA alone, with few side effects.

Download Full-text

Peer review report 2 on “Comparison of femoral nerve block and fascia iliaca block for pain management in total hip arthroplasty: A meta-analysis”

International Journal of Surgery ◽

10.1016/j.ijsu.2017.08.015 ◽

2017 ◽

Vol 37 ◽

pp. 476

Author(s):

Michael Jennings Boscoe

Keyword(s):

Pain Management ◽

Total Hip Arthroplasty ◽

Peer Review ◽

Nerve Block ◽

Hip Arthroplasty ◽

Femoral Nerve Block ◽

Meta Analysis ◽

Femoral Nerve ◽

Total Hip ◽

Fascia Iliaca Block

Download Full-text

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

Orthopedic Reviews ◽

10.4081/or.2017.7063 ◽

2017 ◽

Vol 9 (2) ◽

Cited By ~ 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.

Download Full-text