Abstract
Objective
The optimal continuous peripheral nerve block (CPNB) technique for total hip arthroplasty (THA) that maximizes both analgesia and mobility is unknown. Continuous erector spinae plane (ESP) blocks were implemented at our institution as a replacement for fascia iliaca (FI) catheters to improve our THA clinical pathway. We designed this study to test the hypothesis that this change will increase early postoperative ambulation for elective primary THA patients.
Methods
We identified all consecutive primary unilateral THA cases six months before and six months after the clinical pathway change to ESP catheters. All other aspects of the THA clinical pathway and multimodal analgesic regimen including perineural infusion protocol did not change. The primary outcome was total ambulation distance (meters) on postoperative day 1. Other outcomes included total ambulation on postoperative day 2, combined two-day ambulation distance, pain scores, opioid consumption, inpatient length of stay, and minor and major adverse events.
Results
Eighty-eight patients comprised the final sample (43 FI and 45 ESP). Postoperative day 1 total ambulation distance was greater for the ESP group compared with the FI group (median [10th–90th percentiles] = 24.4 [0.0–54.9] vs 9.1 [0.7–45.7] meters, respectively, P = 0.036), and two-day ambulation distance was greater for the ESP group compared with the FI group (median [10th–90th percentiles] = 68.6 [9.0–128.0] vs 46.6 [3.7–104.2] meters, respectively, P = 0.038). There were no differences in pain scores, opioid use, or other outcomes.
Conclusions
Replacing FI catheters with continuous ESP blocks within a clinical pathway results in increased early ambulation by elective primary THA patients.
Landmark guided continuous erector spinae plane block: An adjunct for perioperative analgesia in a patient with difficult back operated for total hip arthroplasty