| Erector spinae plane block versus fascia iliaca block after total hip arthroplasty: a randomized clinical trial comparing analgesic effectiveness and motor block |
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E Flaviano1, S Bettinelli1, M Assandri2, H Muhammad2, A Benigni1, G Cappelleri3, ER Mariano4,5, LF Lorini1, D Bugada1 |
1Emergency and Intensive Care Department, ASST Papa Giovanni XXIII; Bergamo Italy
2Department of Health Sciences, University of Milan; Milan, Italy
3Anesthesia and Intensive Care Unit, Policlinico di Monza; Monza, Italy
4Department of Anesthesiology, Perioperative and Pain Medicine; Stanford University School of Medicine; Stanford, California, USA
5Anesthesiology and Perioperative Care Service; Veterans Affairs Palo Alto Health Care System; Palo Alto, California, USA |
Corresponding author:
D Bugada,
Email: dariobugada@gmail.com
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Received: 15 October 2022 • Revised: 3 January 2023 • Accepted: 6 January 2023 |
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| Abstract |
Background
Ultrasound-guided, supra-inguinal fascia iliaca block (FIB) provides effective analgesia after total hip arthroplasty (THA), but is complicated by high rates of motor block. The erector spinae plane block (ESPB) is a promising motor-sparing technique. In this study, we test the analgesic superiority of FIB over ESPB, while also comparing motor impairment.
Methods
In this randomized, observer-blinded clinical trial, patients scheduled for THA with spinal anesthesia were randomly assigned to receive either ultrasound-guided FIB or ESPB preoperatively. Primary outcome was morphine consumption at 24 hours after surgery. Secondary outcomes were: pain scores; assessment of sensory and motor block; incidence of postoperative nausea and vomiting and other complications; and development of chronic post-surgical pain.
Results
Sixty patients completed the study. There were no statistically-significant differences in morphine consumption at 24 hours (p = 0.68) or pain scores at any time point. FIB produced more reliable sensory block in the femoral nerve (p = 0.001) and lateral femoral cutaneous nerve (p = 0.018) distributions. However, quadriceps motor strength was better preserved in the ESPB group when compared to the FIB group (p = 0.002). No differences were observed for hip adduction motor strength (p = 0.253). No differences between groups were observed in terms of side effects or chronic pain incidence.
Consclusions: ESPB may represent a promising alternative to FIB for postoperative analgesia after THA. ESPB and FIB offer similar opioid-sparing benefits within the first day after surgery, but ESPB results in less quadriceps motor impairment. |
| Key Words:
Fascia iliaca block, erector spinae plane block, total hip arthroplasty, postoperative analgesia, motor block, enhanced recovery, chronic post-surgical pain |
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