Anesthesia Experts

Periarticular Injection vs Psoas Block for THA-Associated Postoperative Pain

by Leave a Comment

Intraoperative periarticular local anesthetic infiltration (periarticular injection) and psoas compartment block (PCB) may provide comparable analgesia after total hip arthroplasty (THA), according to a prospective clinical trial published in The Journal of Arthroplasty.

A number of regional anesthesia modalities, such as PCB and periarticular injection, have become mainstays of multimodal approaches used during THA.

However, the most efficacious method for reducing patient pain postoperatively has remained unclear, prompting investigators to examine what differences, if any, exist between PCB and periarticular injection, in the first study directly comparing them.

In this study, 99 patients with osteoarthritis undergoing unilateral THA by the direct anterior approach by a single surgeon were enrolled between May 2016 and May 2017. Participants in both groups had comparable demographic variables and demonstrated no differences in preoperative resting or ambulatory pain scores. Individuals were randomly assigned to receive PCB (n=49) or periarticular injection (n=50).

The study’s primary outcomes were resting and ambulatory postoperative pain scores, reported with the 10-point visual analog scale. The secondary outcome was total inpatient narcotic consumption, reported as an oral morphine equivalent.

The periarticular injection group reported lower resting pain scores at 3 hours postsurgery (2.9±2.2 vs 4.0±2.2; P = .036). Resting and ambulatory pain at postoperative days 1 and 2 and at the 3-week follow-up as well as inpatient total narcotic consumption were comparable in both groups. A composite measure of recovery quality (40 composite score; range, 40-200) was higher in the periarticular injection group vs the PCB group (183.1 ± 10.3 vs 177.2 ± 14.0, respectively; P =.020).

Complications were limited and minor, with transient numbness being the only complaint. There were 5 patients (10.2%) in the PCB group who reported this issue, and 1 patient (2.0%) from the periarticular injection group who experienced the same. No complete motor blockade was observed in either group.

Study strengths included prospective randomization, anesthetic technique specificity and reproducibility, and use of 1-month postoperative pain scores. The study was conducted by a single surgeon, a limitation that may affect generalizability of the results.

Both periarticular injection and PCB provided analgesia following surgery, with similar findings regarding 10-point pain scores and narcotic consumption. The slight superiority of periarticular analgesia during the immediate postoperative period, coupled with the concern for overblockade effects in PCB, contribute to recommending periarticular injection as the preferred anesthetic technique for use during THA.

Reference

Fahs AM, Koueiter DM, Kurdziel MD, Huynh KA, Perry CR, Verner JJ. Psoas compartment block vs periarticular local anesthetic infiltration for pain management after anterior total hip arthroplasty: a prospective, randomized study published online February 20, 2018. J Arthroplasty.

Leave a Reply

Call (660) 596-2224
What people thought about us

Testimonials

“As Director of Surgical Services Departments there has been considerable changes have occurred in my department and Anesthesia Experts has always risen to meet our demands of our facility. They have been very pro-active in meeting the increase volumes allowing us to keep our surgeons and patients very satisfied with our services.”

AR BSN 346 beds AL   

“Before AE took over the anesthesia department was described by the surgeons as the worst in the history of our hospital. The prior management company was having a cancelled surgery per day. I am happy to report there has not been one since they have taken over the department. Additionally we have seen a 905 reduction if requested preop
lab tests. The anesthesia department is now the very best hospital department in our entire facility.”

DS CEO 272 beds MS   

“Anesthesia Experts has provided consistent anesthesia providers who display a high degree of integrity, responsibility and professionalism. They have become a more valuable part of our facility and community.”

LR CEO 150 beds TX   

“Even though they are physically located 1000 miles away Anesthesia Experts just does not provide great anesthesia coverage they personally engage surgeons to increase their business. Last year my surgical volume rose by 24% and we are currently 50% ahead of last year and all of that growth is organic.”

JE FACHE CEO AL 92 bed hospital   

“Anesthesia Experts is more responsive than anyone I have dealt with. They are available by phone whenever needed and will be on site for any need or request and has been on site to address issues before we can make the request.”

SW CEO 25 beds NM   

“While problems are extremely rare when they do occur Anesthesia Experts quickly and professionally implements a solution. Our surgical volume has grown over 100 cases per month and now our GI docs want to perform all of their endoscopies in our hospital instead of their GI lab that they own!”

SP CEO 346 beds AL   

“Our anesthesia department was a thorn in my side that kept me awake at night. Anesthesia Experts swept in and brought order to our mess and our department was quickly redirected.”

JAM CNO AL 89 bed hospital   

Add a Testimonial

Verification Captcha