Sciatic Plus Femoral Nerve Blocks Effective on Total Hip Arthroplasty-Related Pain

Adding a sciatic nerve block (SNB) to a continuous femoral nerve block (CFNB) after total hip arthroplasty (THA) significantly reduces pain, according to a study recently published in Orthopedic Reviews.¹

Postoperative analgesia enables patients to recover and rehabilitate quickly, reduces medication consumption, and shortens hospital stays.^2,3 Providing patients with adequate postoperative analgesia might also curtail opioid dependence and abuse, particularly in patients on opioid therapy preoperatively.⁴

Patients in the prospective, 40-person study were randomly assigned to receive either CFNB (n=20; 0.15% ropivacaine, 3 mL/hour) or CFNB plus SNB (n=20; single dose injection of 0.75% ropivacaine 10 mL and 2% mepivacaine 10 mL) after unilateral hip arthroplasty. 

Postoperative pain, which was measured on a 0 to 10 scale, was assessed immediately after and at 6 and 12 hours after surgery. Researchers also recorded the amount of supplemental nonsteroidal anti-inflammatory drugs (NSAIDs) the patients requested during the 12 immediate postoperative hours.

Patients who received SNB plus CFNB had significantly lower pain scores after surgery compared with patients who received only CFNB (6 hours: 2.35±0.62 vs 3.11±1.30; 12 hours: 2.83±1.26 vs 3.50±1.95, P <.05, respectively). There was no significant difference between the groups in the amount of analgesics patients requested.

Adverse events did not differ significantly in the groups. Nausea and vomiting occurred in <15% of patients in both groups. No major complications arose in either group; however, prolonged drowsiness occurred in 3 patients from the combined treatment group.

The researchers cautioned that preoperative use of opioids could lead to complications up to 90 days after surgery and suggested that clinicians inquire about its use before surgery to mitigate any risks. To further reduce the risk associated with opioids, researchers suggest that multimodal drug therapy may provide pain control necessary for uneventful and swifter recovery and rehabilitation.

This study adds to the body knowledge about multimodal drug therapy to control pain following THA, and supports earlier studies on intraarticular injections with a cocktail of medications that do not lead to unnecessary risk.⁵

Given the lack of serious complications, SNB added to CFNB merits consideration to reduce pain scores, and potentially provide a less painful and quicker recovery than CFNB alone.

Summary and Clinical Applicability

Patients who received both CFNB and SNB — compared with CFNB alone — reported greater analgesic effects at 6 and 12 hours after surgery without a significant increase in complications.

Limitations and Disclosures

• The small sample size may not have captured the range of efficacy and safety data seen in larger, more heterogenous populations
• Patients were evaluated at rest up to only 12 hours after surgery
• The methods and timing of the nerve blocks varied significantly in the study

Follow @ClinicalPainAdv

References

1. Nishio S, Fukunishi S, Fukui T, et al. Comparison of continuous femoral nerve block with and without combined sciatic nerve block after total hip arthroplasty: a prospective randomized study. Orthop Rev (Pavia). 2017;9(2):7063. doi:10.4081/or.2017.7063
2. Jiménez-Almonte JH, Wyles CC, Wyles SP, et al. Is local infiltration analgesia superior to peripheral nerve blockade for pain management after THA: a network meta-analysis. Clin Orthop Relat Res. 2016;474:495-516. doi:10.1007/s11999-015-4619-9
3. Andersen KV, Pfeiffer-Jensen M, Haraldsted V, SØballe K. Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty: a randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients. Acta Orthop. 2007;78(2):180-186. doi:10.1080/17453670710013654
4. Menendez ME, Ring D, Bateman BT. Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery. Clin Orthop Relat Res. 2015;473(7):2402-2412. doi:10.1007/s11999-015-4173-5
5. Nakai T, Nakamura T, Nakai T, Onishi A, Hashimoto K. A study of the usefulness of a periarticular multimodal drug cocktail injection for pain management after total hip arthroplasty. J Orthop. 2013;10(1):5-7. doi:10.1016/j.jor.2013.01.011