Analgesia for total hip replacement: Epidural analgesia versus femoral nerve blockade?
The pain management, neuroendocrine and metabolic responses to surgery were compared in two groups of patients undergoing a total hip arthroplasty; one receiving epidural anaesthesia (EPI, n = 12) and the other a femoral nerve block (FNB1 n = 12). The general anaesthesia protocol was similar for the two groups. The epidural or femoral catheters were used for intraoperative analgesia and to provide postoperative pain relief during the first 24 hours. On the second postoperative day the epidural or the femoral catheter was withdrawn and a Patient Controlled Analgesia (PCA) using piritramide was started. The neuroendocrine and metabolic reactions were larger in the FNB compared to the EPI group, with an increase of the postoperative cortisol plasma level and of the cortisol and nitrogen urinary excretion in the former group (P < 0.01). Intraoperative blood loss, transfused blood volumes and the number of transfused patients were similar in the two groups. Intraoperative fluid administration was also comparable. Isoflurane consumption was identical in the two groups. A good postoperative analgesia was achieved, with a trend towards a smaller intravenous opiate consumption in the FNB group, particularly during the first eight hours after the onset of the PCA (P > 0.02). These results indicate that the femoral nerve block may be a safe and effective technique for pain management after a total hip arthroplasty. It ensures good analgesia without entire suppression of the stress response. Femoral analgesia is not associated with haemodynamic changes or motor blockade allowing early mobilisation. However the impact on morbidity remains to be evaluated.
Duke Scholars
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Published In
ISSN
Publication Date
Volume
Issue
Start / End Page
Related Subject Headings
- Anesthesiology