COMPARATIVE POSTOPERATIVE ANALGESIA WITH FEMORAL NERVE BLOCK ”3-IN-1” AND WITH FASCIA ILIACA COMPARTMENT NERVE BLOCK AFTER HIP ALLOARTHROPLASTY

  • Miloš P. Stojiljković Univerzitet u Istočnom Sarajevu, Medicinski fakultet u Foči, Foča, Republika Srpska, Bosna i Hercegovina

Sažetak


Hip arthroplasty is one of the most common operations in elderly population. Pre- and postoperative risks increase their postoperative morbidity and mortality. One of the most important factors, which is included in the perioperative risks, is pain. Control of postoperative pain diminishes incidence and severity of complication afterwards.

We compared three different techniques of pain control in 30 patients scheduled for elective hip arthroplasty: 1) pharmacological - morphine 5 or10 mg iv q6h, depending on body weight, paracetamol 1 g IV q6h  (MP), 2) nerve block: femoral nerve block, single shot (FNB) and 3) fascia iliaca compartment nerve block  (FICNB).

Measurement of pain intensity was performed with numerical pain scale (NPS). Systolic blood pressure and consumption of additional analgesics on demand were monitored, as well as the duration of nerve blocks.

Both nerve blocks produced significantly lower pain scores than the purely pharmacological approach (MP 5.4+0.6 vs. FNB 2.8+1.6 and FICNB 2.9+1.2 after first postoperative hour). Consequently, the first group required more additional morphine and paracetamol after first hour compared to FNB and FICNB groups. Morphine was significantly more frequently added in the MP group  (3.4+0.4 mg/kg IV) than in the FNB  (2.1+0.5 mg/kg IV) and FICNB (2.5+0.4 mg/kg IV). Maximal duration of analgesia was 5 hours in MP group compared to 9 and 8 hours after FNB and FICNB, respectively.

Postoperative analgesia with blocks enables better pain control, better cardiovascular stability and less adverse effect than the classical morphine-based analgesia.

Biografija autora

Miloš P. Stojiljković, Univerzitet u Istočnom Sarajevu, Medicinski fakultet u Foči, Foča, Republika Srpska, Bosna i Hercegovina
Redovni profesor, uža naučna oblast farmakologija i farmacija

Reference

Stevens RD, Van Gessel E, Flory N, Fournier R, Gamulin Z. Lumbar plexus block reduces pain and blood loss in total hip arthroplasty. Anesthesiology 2000;93:115-21.

McLaughlin MA, Orosz GM, Magaziner J, et al. Preoperative status and risk of complications in patients with hip fracture. J Gen Intern Med 2006;21:219-25.

Morrison RS, Magaziner J, McLaughlin MA, et al. The impact of postoperative pain on outcomes following hip fracture. Pain 2003;103:303-11.

Brennan F, Carr DB, Cousins M. Pain management: A fundamental human right. Anesth Anagl 2007;105:205-21.

Garimella V, Cellini C. Postoperative pain control. Clin Colon Rectal Surg 2013;26:191-6.

Inoue K, Fujisawa H, Motonaga A, et al. Anti-inflammatory effects of etodolac: Comparison with other non-steroidal anti-inflammatory drugs. Biol Pharm Bull 1994;17:1577-83.

Monzón GD, Vazquez J, Jauregui RJ, Iserson VK. Pain treatment in post traumatic hip fracture in the elderly: regional block vs. systemic nonsteroidal analgesics. Int J Emerg Med 2010;3:321– 5.

Nerve Blocks for Postoperative Analgesia: Choices After Common Lower Extremities Procedures. J NY School Reg Anesth Vol 10, March 2009. http://www.nysora.com/newsletterz/jnysora/jnysora-volume-10/3329-nerve-blocks-for-postoperative-analgesia-choices-after-common-lower-extremity-procedures.html.

Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravascular technic of lumbar plexus anaesthesia: The "3-in-1" block. Anesth Analg 1973;52:989-96.

Rosenblatt RM. Continuous femoral anesthesia for lower extremity surgery. Anesth Analg 1980;59:631-2.

Dalens B, Vanneuville G, Alain Tanguy A. Comparison of the fascia iliaca compartment block with the 3-in-1 block in children. Anesth Analg 1989; 69:705–3.

Chudinov A, Berkenstadt H, Salai M, Cahana A, Perel A. Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures. Reg Anesth Pain Med 1999;24:563-68.

Singelyn FJ, Vanderelst PE, Gouverneur JA. Extended femoral nerve sheath block after total hip arthroplasty: Continuous versus patient-controlled techniques. Anesth Analg 2001;92:455-9.

Fournier R, Van Gessel E, Gaggero G, et al. Postoperative analgesia “3-in-1” femoral nerve block after prosthetic hip surgery. Can J Anaesth 1998;45:34–8.

Bonica J. Postoperative pain. In: Bonica J, editor. The management of pain. 2nd ed. Philadelphia: Lea & Febiger, 1990, p 461– 80.

Hongling N, Yang Y, Wang et al. Y Effects of continuous fascia iliaca compartment blocks for postoperative analgesia in patients with hip fracture. Pain Res Manag. 2015 Jul-Aug; 20(4): 210–212.

Høgh A, Dremstrup L, Jense SS, Lindholt J. Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture. Strat Traum Limb Recon 2008;3:65–70.

Objavljeno
2016/10/24
Rubrika
Stručni članak