Comparison between combined suprainguinal fascia iliaca compartment block with intra-articular bupivacaine and suprainguinal fascia iliaca compartment block in total hip arthroplasty: randomized double blinded controlled trial

Abstract

Background: Hip innervation is complex, with contributions from the lumbar plexus and sacral plexus. In any surgical approach, the nerves are affected in both the lumbar and sacral plexus. Fascia iliaca compartment block (FICB) could be effective analgesia in total hip arthroplasty (THA), but some patients require morphine for breakthrough pain. This may be due to FICB only blocking the anterolateral aspect of the hip joint, failing to block the posterior aspect. However, blocking the sacral plexus may lead to adverse effects, such as delayed ambulation and the risk of foot drop. Intra-articular (IA) injection of local analgesics after joint capsule closure is effective in relieving postoperative pain. We hypothesized that combined FICB with IA bupivacaine would enhance analgesic efficacy compared with FICB alone. Methods: Twenty-six patients undergoing primary total hip arthroplasty under spinal anesthesia were randomly allocated to receive either a combined suprainguinal fascia iliaca compartment block (S-FICB) with IA (n = 13), using 40 ml of 0.25% bupivacaine in the S-FICB and 0.5% bupivacaine injected into the intraarticular hip joint after surgical wound closure, or S-FICB alone (n = 13), using 40 ml of 0.25% bupivacaine. Following the block administration, a blinded observer recorded cumulative breakthrough morphine consumption, pain scores at 0, 6, 12, 24, and 48 h, opioid-related side effects, as well as the length of hospital stay and patient satisfaction. Results: Compared with S-FICB with IA and S-FICB alone, there was no statistic significant in morphine consumption in 0 h (P = 0.960), 6 h (P = 0.169), 12 h (P = 0.125), 24 h (P = 0.186), and 48 h (P = 0.311) in this study. No statistic significant were found in secondary outcome in term of static and dynamic NRS scores, incidence of nausea and vomiting, block related LAST and patient satisfaction. Conclusion: The addition of 20 ml of 0.5% intra-articular bupivacaine to a suprainguinal fascia iliaca compartment block did not provide additional postoperative analgesic benefits for patients undergoing total hip arthroplasty.