Effect of suprainguinal fascia iliaca compartment block on postoperative opioid consumption and functional recovery in posterolateral-approached total hip arthroplasty: a single-blind randomized controlled trial

Abstract

IntroductionPosterolateral-approached total hip arthroplasty (PLTHA) is followed by moderate to severe postoperative pain. Suprainguinal fascia iliaca compartment block (SFICB) has been proposed as a promising analgesia technique.MethodsData from 86 patients scheduled for PLTHA with spinal anesthesia were analyzed in this prospective randomized controlled trial. Patients were randomly divided into two groups of 43 patients each. As opposed to the control group (group C), ropivacaine group (group R) received additional SFICB using 40 mL of 0.375% ropivacaine. As primary endpoint, blind observers noted total morphine consumption at postoperative 48 hours. Secondary endpoints were pain at rest and mobilization on 0–10 Numeric Rating Scale (rest and dynamic NRS) at fixed time points (1 hour and 6 hours after surgery, and at day 1 and day 2 at 8:00, 13:00 and 18:00 hours), walking performance at day 1 and day 2; postoperative complications including morphine-related side effects or orthostatic intolerance symptoms such as dizziness, nausea, blurred vision or vasovagal syncope.ResultsA 48-hour morphine consumption (mg; median (IQR)) was significantly lower in group R than in group C (11 (8.5–15.5)) vs 26 (21–33.5), p<0001), as well as incidence of morphine-related side effects such as nausea at day 1 (p=0.04) and day 2 (p<0.01). Rest and dynamic NRS were globally significantly lower in group R than in group C (p<0.01). Group R showed less orthostatic intolerance at day 1 (p<0.001) and day 2 (p<0.01) and better functional walking performance at day 1 (<0.001) and day 2 (<0.001).DiscussionIn PLTHA, SFICB provides opioid sparing, improved postoperative pain control, and enhanced functional recovery.Trial registration numberNCT04574479.

Assessing postoperative benefits of regional blocks: an issue that should be noticed

“…In a single-blind randomized controlled trial including 86 patients who underwent posterolateral approach total hip arthroplasty, Carella et al 1 assessed the effects of suprainguinal fascia iliaca compartment block on postoperative opioid consumption and functional recovery and showed that the suprainguinal fascia iliaca compartment block provided opioid sparing, improved postoperative pain control and enhanced functional recovery. Other than the limitations described by authors in the discussion, however, this study used a single-mode postoperative analgesia strategy in the control patients, that is, patient-controlled analgesia with morphine.…”

Erector spinae plane versus fascia iliaca block after total hip arthroplasty: a randomized clinical trial comparing analgesic effectiveness and motor block

“…The fascia iliaca block (FIB) is an established and effective technique, especially when ultrasound (US) guidance and proximal approaches are used. Recent studies have recently demonstrated that US guided FIB with a supra-inguinal approach is associated with improved pain control and significant opioid-sparing effect after THA [5,6].…”

Comparison between supra-inguinal fascia iliaca and pericapsular nerve group blocks on postoperative pain and functional recovery after total hip arthroplasty

“…A longitudinal supra-inguinal approach to the fascia iliaca compartment has been shown to be efficient at relieving pain after both the anterior and posterolateral approach for THA 9,10 . The supra-inguinal fascia iliaca block (SFIB) performed in patients having received spinal anaesthesia for surgery reduces postoperative opioid consumption, improves postoperative pain management and functional performance during the first 48 h after surgery 10 . Similarly, the pericapsular nerve group (PENG) block has been demonstrated to be effective in PLTHAs, not only regarding postoperative pain management but also because of preservation of quadriceps femoris strength 11–13 .…”