Comparison of psoas compartment block and epidural block for postoperative analgesia in hip surgeries

Context: Psoas compartment block via lumbar paravertebral approach has been compared with epidural block for postoperative pain relief following hip surgery. Settings and Design: This prospective, randomized study was conducted in the department of Anesthesia in a tertiary care hospital. Materials and Methods: This study was conducted on 60 patients undergoing unilateral hip surgery. They were randomly assigned to either psoas compartment (P) or epidural (E) group (30 in each group). A lumbar paravertebral (psoas compartment) or epidural catheter was placed before the start of surgery. A subarachnoid block using 0.5% hyperbaric bupivacaine and fentanyl was subsequently administered. After 2 h, a loading dose of 10 ml of 0.25% bupivacaine was given, and infusion of the same drug started at 5 ml/h in group P and 5 ml/h of 0.125% bupivacaine in group E using an elastomeric infusion pump. The patients were observed for 24 h and quality of pain relief with both the techniques was compared. Statistical Analysis: Categorical variables were analyzed with Chi-square test while continuous variables were analyzed with Student's t-test. Visual analog scale was expressed as median and was analyzed with Mann–Whitney test. A software program (SPSS 21) was used. P <0.05 was considered significant. Results: The mean duration of postoperative analgesia in the epidural group was 551.11 min compared to 427.25 min in the psoas compartment group (P > 0.05), which was not statistically significant. Mean pain scores at 4 and 8 h postoperatively were higher in the psoas compartment block resulting in greater rescue analgesic requirement in this group. Conclusions: Psoas compartment block can be considered an alternative in patients with relative contraindications to epidural block such as those on deep vein thrombosis prophylaxis with anticoagulants.