Clin Orthop Surg.  2015 Jun;7(2):164-170. 10.4055/cios.2015.7.2.164.

Comparison of Continuous Epidural Analgesia, Patient-Controlled Analgesia with Morphine, and Continuous Three-in-One Femoral Nerve Block on Postoperative Outcomes after Total Hip Arthroplasty

• Tetsunaga
• Sato T
• Shiota N
• Tetsunaga
• Yoshida M
• Okazaki Y
• Yamada K

• KMID: 2164540
• DOI: http://doi.org/10.4055/cios.2015.7.2.164

Abstract

BACKGROUND
Postoperative pain relief can be achieved with various modalities. However, there are only few reports that have analyzed postoperative analgesic techniques in total hip arthroplasty patients. The aim of this retrospective study was to compare the postoperative outcomes of three different analgesic techniques after total hip arthroplasty.
METHODS
We retrospectively reviewed the influence of three analgesic techniques on postoperative rehabilitation after total hip arthroplasty in 90 patients divided into three groups (n = 30 patients per group). Postoperative analgesia consisted of continuous epidural analgesia (Epi group), patient-controlled analgesia with morphine (PCA group), or a continuous femoral nerve block (CFNB group). We measured the following parameters relating to postoperative outcome: visual analog scale scores, the use of supplemental analgesia, side effects, length of the hospital stay, plasma D-dimer levels, and the Harris hip score.
RESULTS
Each group had low pain scores with no significant differences between the groups. The PCA group had a lower frequency of supplemental analgesia use compared to the Epi and CFNB groups. Side effects (nausea/vomiting, inappetence) and day 7 D-dimer levels were significantly lower in the CFNB group (p < 0.05). There were no significant differences between the groups in terms of the length of the hospital stay or the Harris hip score.
CONCLUSIONS
Although there were no clinically significant differences in outcomes between the three groups, the CFNB provided good pain relief which was equal to that of the other analgesics with fewer side effects and lower D-dimer levels in hospitalized patients following total hip arthroplasty.

Keyword

Nerve block; Epidural anesthesia; Morphine; Total hip arthroplasty

MeSH Terms

Adult
Aged
Aged, 80 and over
*Analgesia, Epidural/methods
*Analgesia, Patient-Controlled
Analgesics, Opioid/*administration & dosage
*Arthroplasty, Replacement, Hip
Female
*Femoral Nerve
Fibrin Fibrinogen Degradation Products/analysis
Humans
Length of Stay
Male
Middle Aged
Morphine/*administration & dosage
*Nerve Block/methods
Pain, Postoperative/*prevention & control
Retrospective Studies
Treatment Outcome
Analgesics, Opioid
Fibrin Fibrinogen Degradation Products
Morphine

Figure

• 

  Fig. 1 (A) VAS for each group at 24 hours postoperatively. The VAS scores were not significantly different among the three groups. (B) Additional analgesic treatment was given to each of the three groups for two days after surgery. Values are presented as mean ± standard deviation. VAS: visual analog scale, Epi: epidural analgesia, PCA: patient-controlled analgesia, CFNB: continuous femoral nerve block. *p < 0.05.

• 

  Fig. 2 Food intake of the three groups on postoperative day 1. Values are presented as mean ± standard deviation. Epi: epidural analgesia, PCA: patient-controlled analgesia, CFNB: continuous femoral nerve block. *p < 0.05. **p < 0.01.

• 

  Fig. 3 D-dimer levels preoperatively (day 0) and on postoperative days 1, 3, and 7. Values are presented as mean ± standard deviation. Epi: epidural analgesia, PCA: patient-controlled analgesia, CFNB: continuous femoral nerve block. *p < 0.05.

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