Key result
Peripheral nerve block plus IV PCA is linked to lower postoperative resting VAS scores versus PCA alone.
Why the study?
The study was conducted to evaluate the effect of peripheral nerve block on immediate postoperative analgesia and early functional outcomes in patients undergoing total hip arthroplasty.
Does peripheral nerve block added to IV PCA improve postoperative analgesia in patients undergoing total hip arthroplasty?
Cohort (n=353)
Does peripheral nerve block added to IV PCA improve postoperative analgesia in patients undergoing total hip arthroplasty?
Answers are grounded in this paper and cite their sources.
Peripheral nerve block combined with IV PCA provides superior immediate postoperative analgesia at rest and during early activity compared to IV PCA alone after total hip arthroplasty.
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.
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Park et al. (2022) conducted a cohort in Total hip arthroplasty (n=353). Peripheral nerve block (PNB) and intravenous patient-controlled analgesia (IV PCA) vs. Intravenous patient-controlled analgesia (IV PCA) alone was evaluated on Visual analogue scale (VAS) at rest and activity status at postoperative 6, 24, and 48 hours (p=0.000, 0.001, 0.000, 0.004). Peripheral nerve block combined with IV PCA significantly reduced postoperative resting VAS scores at 6, 24, and 48 hours compared to IV PCA alone (p=0.000, 0.001, 0.000).
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