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An Obturator Nerve Block Does Not Alleviate Postoperative Pain After Total Hip Arthroplasty: A Randomized Clinical Trial

An Obturator Nerve Block Does Not Alleviate Postoperative Pain After Total Hip Arthroplasty: A Randomized Clinical Trial

Niels Dalsgaard Nielsen, Charlotte Runge, Louise Clemmesen, Jens Børglum, Lone Ramer Mikkelsen, Jens Rolighed Larsen, Thomas Dahl Nielsen, Kjeld Søballe, Thomas Fichtner Bendtsen

Reg Anesth Pain Med. 2019 Jan 23;rapm-2018-100104.

PMID: 30679337

Abstract:

Background and objectives:
A substantial group of patients suffer from moderate to severe pain following elective total hip arthroplasty (THA). Due to the complex innervation of the hip, peripheral nerve block techniques can be challenging and are not widely used. Since the obturator nerve innervates both the anteromedial part of the joint capsule as well as intra-articular nociceptors, we hypothesized that an obturator nerve block (ONB) would decrease the opioid consumption after THA.
Methods:
Sixty-two patients were randomized to receive ONB or placebo (PCB) after primary THA in spinal anesthesia. Primary outcome measure was opioid consumption during the first 12 postoperative hours. Secondary outcome measures included postoperative pain score, nausea score and ability to ambulate.
Results:
Sixty patients were included in the analysis. Mean (SD) opioid consumption during the first 12 postoperative hours was 39.9 (22.3) mg peroral morphine equivalents (PME) in the ONB group and 40.5 (30.5) mg PME in the PCB group (p=0.93). No difference in level of pain or nausea was found between the groups. Paralysis of the hip adductor muscles in the ONB group reduced the control of the operated lower extremity compared with the PCB group (p=0.026). This did, however, not affect the subjects' ability to ambulate.
Conclusions:
A significant reduction in postoperative opioid consumption was not found for active versus PCB ONB after THA.
Trial registration number:
NCT03064165 and 2017-000068-14.

Chemicals Related in the Paper:

Catalog Number	Product Name	Structure	CAS Number	Price
AP34883415	PCB No 14		34883-41-5	Price

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