Comparison of analgesic effects of ultrasound-guided continuous iliac fasicia block using different approa-ches after total hip arthroplasty / 临床麻醉学杂志

ABSTRACT

Objective To compare the analgesic effect of continuous iliac fasicia block with dif-ferent approaches for patients undergoing total hip arthroplasty (THA).Methods Forty patients,21 males and 9 females,ASA physical status Ⅰ or Ⅱ,scheduled for elective hip arthroplasty surgery in Tongji Hospital from June to December 2016 were enrolled and randomly divided into two groupsparallel group (n =20)or vertical group (n =20).Patients received ultrasound-guided continuous iliac fasicia block with a short-axis in-plane technique in the parallel group and a long-axis in-plane tech-nique in the vertical group after the surgery.All patients had a 10 ml bolus of lidocaine 1% via the catheter followed by an infusion of ropivacaine 0.2% at 4 ml/h for 48 h.The ultrasound imaging time,procedure time and the depth of catheter were recorded.Cumulative frequency of patient-con-trolled nerve blockade analgesia (PCNA),ropivacaine consumption,pain scores at rest,the success rate of block,satisfaction scores and postoperative complications were recorded at every six hours during 48 h after the surgery.Results The ultrasound imaging time and procedure time in the vertical group were longer than in the parallel group (P <0.05).The depth of catheter in the vertical group was significantly greater than in the parallel group (P <0.05).The cumulative frequency of PCNA in the vertical group was significantly less than the parallel group (P <0.05 ).The success rate of the lateral femoral cutaneous nerve block in the vertical group was significantly higher than the parallel group at 6,12,18,24,30,36,42,48 h.The cumulative ropivacaine consumption at 24,30,36 h in the vertical group was significantly less compared with the parallel group (P <0.05).The pain inten-sity at rest was less in the vertical group compared with the parallel group at 24,30,36,42,48 h (P<0.05).There were no significant differences in the success rate of the femoral nerve block,satisfac-tion scores and related complications between the two groups.Conclusion Continuous iliac fasicia block with the short-axis in-plane and long-axis in-plane technique can effectively provide the postop-erative analgesic effects for patients undergoing THA.The long-axis in-plane technique in the vertical group with a higher success rate of the lateral femoral cutaneous nerve block can significantly reduce the ropivacaine consumption and pain scores.