Peripheral Nerve Block for Pain Management after Total Hip Arthroplasty: A Retrospective Study with Propensity Score Matching

Abstract

This study aimed to evaluate the effect of a peripheral nerve block (PNB) on immediate postoperative analgesia and the early functional outcomes for patients who underwent total hip arthroplasty (THA). From January 2016 to August 2021, 353 patients who underwent THA were divided into two groups: the patient-controlled analgesia (PCA) group (n = 217) who received only intravenous (IV) analgesia, and others who received IV PCA and PNB (PCA + PNB group) (n = 136). After propensity score matching for age and sex, 136 patients from each group were included in the study. Primary outcomes were the visual analogue scale (VAS) at rest, activity status at postoperative 6, 24, 48 h. Secondary outcomes were functional scores by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, Harris Hip Score (HHS) and rescue medications used. The postoperative VAS at 6, 24, 48 h at rest and 6 h at activity were significantly lower in the PCA + PNB group (p = 0.000, 0.001, 0.000, 0.004 in order). There was no significant difference for postoperative 3-month HHS (p = 0.218), except for 3-month WOMAC index (p = 0.001). There were no significant differences for VAS between the PNB methods except femoral nerve block (FNB) and fascia iliaca compartment block (FICB) at postoperative activity 48 h (p = 0.028). There was no significant difference in the total count and amount of rescue medication (p = 0.091, 0.069) and difference in the quadriceps weakness was not noted. Therefore, PNB is beneficial for patients who undergo THA as it provides sufficient postoperative analgesia, especially during immediate postoperative resting pain without quadriceps weakness.

Postoperative Pain in Orthopedics

“…Peripheral nerve blocks (PNB) have remarkable benefits for immediate postoperative pain control after primary total hip arthroplasty (THA). The analgesic effect of PNB with IV PCA was better than conventional IV PCA alone [3].…”

Comparison of fascia iliaca block with quadratus lumborum block for hip arthroplasty: A meta-analysis of randomized controlled trials

“…Many types of peripheral nerve blocks have been developed to minimize perioperative pain and maximize physical function for hip arthroplasty, such as FIB and QLB. [26,27] However, their comparison for pain control is unclear after hip arthroplasty. Our Regarding the sensitivity analysis, significant heterogeneity was seen among the included studies for the pain scores at 12 hours.…”

Peripheral Nerve Blockade in Total Hip Arthroplasty: A Retrospective Study with Propensity Score Matching

“…The pain relief effect of PNB in THA at early postoperative period is well known, and PNB has been considered an essential component of pain management [15,[22][23][24]. In this study, femoral nerve block, quadratus lumborum block, fascia iliaca compartment block, lateral femoral cutaneous nerve block, and pericapsular nerve group block after THA were performed according to the decision of the anesthesiologist in our institution.…”

“…Several studies have shown that peripheral nerve block (PNB) after THA has excellent advantages in terms of pain control, as well as in decreasing the risk of various postoperative complications in patients [15][16][17]. There are many methods of PNB that can be applied to THA.…”