Anesthésie et recherche clinique
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Abstrait

A Randomized and Observer Blinded Comparison of Continuous Femoral Block and Fascia Iliaca Compartment Block in Hip Replacement Surgery

Background: Techniques, analgesic effects and functional outcome of continuous femoral nerve and fascia iliaca compartment blocks were compared in patients undergoing hip replacement surgery.

Methods: 80 patients were enroled in this randomized and observer-blinded study. 40 patients received a femoral nerve catheter with a stimulating catheter (FEM group) and 40 patients a fascia iliaca compartment catheter (FIC group). Before surgery, the catheters were placed. 50 mL prilocaine 1% was administered and a continuous infusion of ropivacaine 0.2% was maintained for 24 hours. Postoperative pain management with non-steroidal antiinflammatory agents was standardized during the first 24 hours. No bolus application of a local anesthetic was allowed during this period.

Intravenous opioide PCA with piritramide (comparable with morphin) was provided for 24 hours, and the patients were instructed to titrate their pain below a level of visual analogue scale of 3. We evaluated the catheter placement time, the time until complete sensory and motor block, the analgesic efficacy and functional outcome with WOMAC Index, Harris Hip Score, Lequesne Score and SF 36 questionnaire.

Results: Catheter placement was faster in the FIC group (3 minutes vs. 5 minutes in mean; p <0.05). Time until sensory and motor blockade was faster in the FEM group except for the lateral part of the thigh. No significant difference was noted between the groups regarding median VAS pain values and consumption of piritramide within 24 hours. No differences in functional outcome after 12 and 90 days of surgery could be observed.

Conclusions: The fascia iliaca compartment catheter can be placed more quickly than the femoral nerve catheter with the stimulating catheter technique, but onset time of sensory and motor blockade is longer when performing the fascia iliaca compartment technique. Both techniques have equivalent postoperative analgesic efficacy in hip replacement surgery without any difference in functional outcome. In case of contraindications for a classic femoral nerve block, the fascia iliaca compartment block is an equivalent procedure.