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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2014 January;80(1):48-57
Supplemental single shot femoral nerve block for total hip arthroplasty: impact on early postoperative care, pain management and lung function
Wiesmann T. 1, Steinfeldt T. 1, Wagner G. 1, Wulf H. 1, Schmitt J. 2, Zoremba M. 1 ✉
1 Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Marburg, Germany;
2 Department of Orthopedics and Rheumatology, University Hospital Marburg, Germany
Background and aim: Peripheral regional anesthesia is beneficial in the management of postoperative pain in hip surgery, and can also reduce post-operative care unit (PACU) stay. Its opioid-sparing actions may also be beneficial for respiratory mechanics and pulmonary function. The aim of our pilot study was to evaluate the effect of a supplemental single shot femoral block for elective total hip arthroplasty on early respiratory function and postoperative management within the first 24 postoperative hours.
Methods: We prospectively studied 80 patients undergoing total hip arthroplasty. Written informed consent was obtained after ethics committee approval. Forty patients were randomLy assigned to receive single shot femoral nerve block (FNB) using 15mL bupivacaine 0.25% and 20 mg clonidine while the remainder received standard treatment without nerve block (STN). Premedication and general anesthesia were standardized. Pulse oximetry saturation and spirometric lung function were measured preoperatively (baseline) and at 0.5 h, 2 h, 6 h and 24 h, after extubation breathing room air. PACU surveillance and postoperative pain therapy was standardized.
Results: Oxygen saturation and spirometry results were significantly better within the FNB group during the first six postoperative hours. Although VAS scores during the PACU stay did not significantly differ between the study groups, PACU discharge criteria were met earlier in the FNB group (116±40min [mean±SD] vs. 152±47 min in the STN group). The FNB group exhibited significantly lower VAS scores at 6 and 24 hours.
Conclusion: Supplemental single shot femoral nerve block for total hip arthroplasty resulted in earlier PACU discharge capability, improved lung function during the first six hours and better pain control within the first 24 postoperative hours.