Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Current Anesthesiology Reports
Erschienen in: Current Anesthesiology Reports 4/2021

28.09.2021 | Regional Anesthesia (P Kukreja, Section Editor)

Regional Anesthesia for Total Hip Arthroplasty: Essential Anatomy, Techniques, and Current Literature Review

verfasst von: Promil Kukreja, Lauren Mason, Joel Feinstein, S. Elizabeth Morris, Hari Kalagara

Erschienen in: Current Anesthesiology Reports | Ausgabe 4/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Total hip arthroplasty (THA) is one of the most common joint arthroplasty surgical procedures. The goal of achieving adequate acute pain management in the post-operative setting remains a challenge. The purpose of this literature review was to examine the different modes of analgesia that are used to manage post-operative pain in patients undergoing hip surgery, primarily THA.

Recent Findings

To date, there exists no gold standard regional or multimodal pain regimen used for patients undergoing THA. Combining peripheral nerve blocks (PNB) with adjunctive measures such as local infiltration analgesia, gabapentenoids, systemic non-steroidal anti-inflammatory drugs (NSAIDs), and spinal (intrathecal) opioids allows the anesthesiologist to provide optimal analgesia with potential for minimal adverse effects, as well as prolonging the duration of pain control.

Summary

Choosing the correct multimodal analgesic regimen (MMA) in patients undergoing THA is of utmost importance, as this can minimize side effects, optimize recovery, reduce the use of opioid consumption, and decrease overall post-operative morbidity and mortality. Newer regional anesthesia blocks like quadratus lumborum block (QLB) and pericapsular nerve group (PENG) block have shown to provide effective analgesia for THA in recent studies.
Literatur
1.••
Memtsoudis SG, Sun X, Chiu YL. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013;118:1046–58. This study concluded that utilization of neuraxial anesthesia for primary joint arthroplasty is associated with superior perioperative outcomes like 30-day mortality, length of stay and in-hospital complications.PubMedCrossRef
2.
Kukreja P, MacBeth L, Potter W. Posterior quadratus lumborum block for primary total hip arthroplasty analgesia: a comparative study. Einstein (Sao Paulo). 2019;17(4):eAO4905.PubMedCentralCrossRef
3.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surg Am. 2007;89:780–5.CrossRef
4.
Yeap YL, Butterworth JK. Analgesic techniques after total hip arthroplasty. Anesth Analg. 2011;113:678–88.
5.
Tyagi A, Salhotra R. Total hip arthroplasty and peripheral nerve blocks: limited but salient role? J Anaesthesiol Clin Pharmacol. 2018;34(3):379–80.PubMedPubMedCentralCrossRef
6.
Lewiecki EM, Wright NC, Curtis JR, Siris E, Gagel RF, Saag KG, Singer AJ, Steven PM, Adler RA. Hip fracture trends in the United States, 2002 to 2015. Osteoporos Int. 2018;29(3):717–22.PubMedCrossRef
7.
Dangle J, Kukreja P, Kalagara H. Review of current practices of peripheral nerve blocks for hip fracture and surgery. Curr Anesthesiol Rep. 2020;10:259–66.CrossRef
8.
Wolford ML, Palso K, Bercovitz A. Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000–2010. NCHS Data Brief. 2015;186:1–8.
9.
Fischer HBJ, Simanski CJP. A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia. 2005;60:1189–202.PubMedCrossRef
10.
Bugada D, Bellini V, Lorini LF. Update on selective regional analgesia for hip surgery patients. Anesthesiol Clin. 2018;36:403–15.PubMedCrossRef
11.••
Kukreja P, MacBeth L, Kalagara H, et al. Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study. Reg Anesth Pain Med. 2019;44:1075–9. This was first prospective randomized, double blinded study to report the effectiveness of the QLB for pain control after THA and decreased opioid consumption up to 48 hours after primary THA.
12.
HojerKarlsen AP, Geisler A, Petersen PL. Postoperative pain treatment after total hip arthroplasty: a systematic review. Pain. 2015;156:8–30.CrossRef
13.
Kikuchi M, Mihara T, Mizuno Y. Anterior quadratus lumborum block for postoperative recovery after total hip arthroplasty: a study protocol for a single-center, double-blind, randomized controlled trial. Trials. 2020;21:142.PubMedPubMedCentralCrossRef
14.
McCarthy D, Iohom G. Local infiltration analgesia for postoperative pain control following total hip arthroplasty: a systematic review. Anesthesiol Res Pract. 2012;2012:709531.PubMedPubMedCentral
15.
Kukreja P, Avila A, Northern T, Dangle J, Kolli S, Kalagara H. A retrospective case series of pericapsular nerve group (PENG) block for primary versus revision total hip arthroplasty analgesia. Cureus. 2020;12(5):e8200.PubMedPubMedCentral
16.
Winnie AP, Ramamurthy S, Durrani Z, Radonjic R. Plexus blocks for lower extremity surgery: New answers to old problems. Anesth Rev. 1974;1:11–6.
17.
Stevens R, Van Gessel E, Flory N, Fournier R, Gamulin Z. Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. Anesthesiology. 2000;93:115–21.PubMedCrossRef
18.
Ahamed ZA, Sreejit MS. Lumbar plexus block as an effective alternative to subarachnoid block for intertrochanteric hip fracture surgeries in the elderly. Anesth Essays Res. 2019;13(2):264–8.PubMedPubMedCentralCrossRef
19.
Kirchmair L, Entner T, Wissel J, Moriggl B, Kapral S, Mitterschiffthaler G. A study of the paravertebral anatomy for ultrasound-guided posterior lumbar plexus block. Anesth Analg. 2001;93(2):477–81.PubMedCrossRef
20.•
Ilfeld BM, Mariano ER, Madison SJ. Continuous femoral versus posterior lumbar plexus nerve blocks for analgesia after hip arthroplasty: a randomized, controlled study. Anesth Analg. 2011;113(4):897–903. This study concluded that a continuous femoral nerve block is an acceptable analgesic alternate to a continuous posterior lumbar plexus block, however early ambulation is suffers with FNB.PubMedPubMedCentralCrossRef
21.
Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d’Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91:8–15.PubMedCrossRef
22.
Diwan S. Fascia iliaca block- an anatomical and technical description. J Anaesth Crit Care Case Rep. 2015;1(1):27–30.
23.
Dalens B, Vanneuville G, Tanguy A. Comparison of the fascia iliaca compartment block with the 3-in-1 block in children. Anesth Analg. 1989;69(6):705–13. Erratum in: Anesth Analg 1990;70(4):474.PubMedCrossRef
24.
Nassar H, Hasanin A, Sewilam M. Transmuscular quadratus lumborum block versus suprainguinal fascia iliaca block for hip arthroplasty: a randomized, controlled pilot study. Local Reg Anesth. 2021;14:67–74.PubMedPubMedCentralCrossRef
25.
Hebbard P, Ivanusic J, Sha S. Ultrasound-guided supra-inguinal fascia iliaca block: a cadaveric evaluation of a novel approach. Anaesthesia. 2011;66(4):300–5.PubMedCrossRef
26.
Kumar K, Pandey RK, Bhalla AP, Kashyap L, Garg R, Darlong V, Malhotra R, Yadav CS. Comparison of conventional infrainguinal versus modified proximal suprainguinal approach of Fascia Iliaca Compartment Block for postoperative analgesia in Total Hip Arthroplasty. A prospective randomized study. Acta Anaesthesiol Belg. 2015;66(3):95–100.PubMed
27.
Wang N, Li M, Wei Y, Guo X. A comparison of two approaches to ultrasound-guided fascia iliaca compartment block for analgesia after total hip arthroplasty. Zhonghua Yi Xue Za Zhi. 2015;95(28):2277–81.PubMed
28.
Vermeylen K, Matthias D, Leunen I. Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study. Reg Anesth Pain Med. 2019;44:483–91.CrossRef
29.
Albrecht E, Chin KJ. Advances in regional anaesthesia and acute pain management: a narrative review. Anaesthesia. 2020;75:e101–10.PubMedCrossRef
30.
Blanco R. TAP block under ultrasound guidance: the description of a “no pops” technique:271. Reg Anesth Pain Med. 2007;32:130.
31.•
El-Boghdadly K, Elsharkawy H, Short A, Chin KJ. Quadratus lumborum block nomenclature and anatomical considerations. Reg Anesth Pain Med. 2016;41:548–9. In this important letter to editor, the authors propose renaming the QL blocks based on the anatomical location of needle tip placement in relation to the QL muscle.PubMedCrossRef
32.
Elsharkawy H, El-Boghdadly K, Barrington M. Quadratus Lumborum block: anatomical concepts, mechanisms, and techniques. Anesthesiology. 2019;130:322–35.PubMedCrossRef
33.
Pascarella G, Costa F, Del Buono R, Pulitanò R, Strumia A, Piliego C, De Quattro E, Cataldo R, Agrò FE, Carassiti M; collaborators. Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer-masked, controlled trial. Anaesthesia. 2021. https://​doi.​org/​10.​1111/​anae.​15536.
34.•
Girón-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018;43(8):859–63. This is a brief technical report about a novel regional block PENG. The authors also developed a novel ultrasound-guided approach for blockade of articular branches supplying the anterior capsule of hip.PubMed
35.
Birnbaum K, Prescher A, Hepler S, Heller KD. The sensory innervation of the hip joint—An anatomical study. Surg Radiol Anat. 1997;19:371–5.PubMedCrossRef
36.
Short AJ, Barnett JJG, Gofeld M, Baig E, Lam K, Agur AMR, Peng PWH. Anatomic study of innervation of the anterior hip capsule: implication for image-guided intervention. Reg Anesth Pain Med. 2018;43(2):186–92.PubMed
37.
Zhang XH, Li YJ, He WQ, Yang CY, Gu JT, Lu KZ. Combined ultrasound and nerve stimulator guided deep nerve block may decrease the rate of local anesthetics systemic toxicity: a randomized clinical trial. BMC Anesthesiol. 2019;19:103.PubMedPubMedCentralCrossRef
38.
Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mercier FJ, Bouaziz H, Samii K. Major complications of regional anesthesia in France: the SOS regional anesthesia hotline service. Anesthesiology. 2002;97(5):1274–80.PubMedCrossRef
39.••
Guay J, Parker MJ, Griffiths R, Kopp SL. Peripheral nerve blocks for hip fractures: a Cochrane Review. Anesth Analg. 2018;126(5):1695–704. This landmark review focused on the use of peripheral nerve blocks as preoperative and postoperative analgesia for hip fracture surgery and concluded that blocks reduce pain on movement, and reduce time to first mobilization.PubMedCrossRef
40.
Hong HK, Ma Y. The efficacy of fascia iliaca compartment block for pain control after hip fracture: a meta-analysis. Medicine (Baltimore). 2019;98(28):e16157.PubMedPubMedCentralCrossRef
41.
Bravo D, Layera S, Aliste J. Lumbar plexus block versus suprainguinal fascia iliaca block for total hip arthroplasty: a single-blinded, randomized trial. J Clin Anesth. 2020;66:109907.PubMedCrossRef
42.
Desmet M, Balocco AL, Van Belleghem V. Fascia iliaca compartment blocks: different techniques and review of the literature. Best Pract Res Clin Anaesthesiol. 2019;33(1):57–66.PubMedCrossRef
43.
McGraw-Tatum MA, Groover MT, George NE, Urse JS, Heh V. A prospective, randomized trial comparing liposomal bupivacaine vs fascia iliaca compartment block for postoperative pain control in total hip arthroplasty. J Arthroplasty. 2017;32(7):2181–5.PubMedCrossRef
44.
Fujihara Y, Fukunishi S, Niship S, Miura J, Koyanagi S, Yoshiya S. Fascia iliaca compartment block: its efficacy in pain control for patients with proximal femoral fracture. J Orthop Sci. 2013;18:793–7.PubMedCrossRef
45.
Steenberg J, Møller AM. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br J Anaesth. 2018;120(6):1368–80.PubMedCrossRef
46.
Mouzopoulos G, Vasiliadis G, Lasanianos N, Nikolaras G, Morakis E, Kaminaris M. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo controlled trial. J Orthop Traumatol. 2009;10:127–33.PubMedPubMedCentralCrossRef
47.
Wiesmann T, Steinfeldt T, Wagner G, Wulf H, Schmitt J, Zoremba M. Supplemental single shot femoral nerve block for total hip arthroplasty: impact on early postoperative care, pain management and lung function. Minerva Anestesiol. 2014;80(1):48–57.PubMed
48.
Abou-Setta AM, Beaupre LA, Rashiq S, Dryden DM, Hamm MP, Sadowski CA. Comparative effectiveness of pain management interventions for hip fracture: a systemic review. Ann Intern Med. 2011;155:234–45.PubMedCrossRef
49.
Fletcher AK, Rigby AS, Heyes FL. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Ann Emerg Med. 2003;41:227–33.PubMedCrossRef
50.
Haddad FS, Williams RL. Femoral nerve block in extracapsular femoral neck fractures. J Bone Joint Surg Br. 1995;77:922–3.PubMedCrossRef
51.
Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. Biomed Res Int. 2017;2017:2752876.PubMedPubMedCentralCrossRef
52.•
Gupta A, Sondekoppam R, Kalagara H. Quadratus Lumborum Block: a Technical Review. Curr Anesthesiol Rep. 2019;9:257–62. This current review has explained the QL block basic anatomy, the ultrasound anatomy, the ultrasound guided procedure, technical tips and complications.CrossRef
53.
Sa M, Cardoso JM, Reis H, Esteves M, Sampaio J, Gouveia I. Quadratus lumborum block: are we aware of its side effects? A report of 2 cases. [Article in Portuguese. Rev Bras Anestesiol. 2017;68:396–9.
54.
Gitman M, Barrington MJ. Local anesthetic systemic toxicity: a review of recent case reports and registries. Reg Anesth Pain Med. 2018;43:124–30.PubMed
55.
Lin DY, Morrison C, Brown B, Saies AA, Pawar R, Vermeulen M, Anderson SR, Lee TS, Doornberg J, Kroon HM, Jaarsma RL. Pericapsular nerve group (PENG) block provides improved short-term analgesia compared with the femoral nerve block in hip fracture surgery: a single-center double-blinded randomized comparative trial. Reg Anesth Pain Med. 2021;46(5):398–403.PubMedCrossRef
56.
Mistry T, Sonawane KB, Kuppusamy E. PENG block: points to ponder. Reg Anesth Pain Med. 2019;44:423–4.PubMedCrossRef
57.
Ahiskalioglu A, Aydin ME, Celik M. Can high volume pericapsular nerve group (PENG) block act as a lumbar plexus block? J Clin Anesth. 2020;61:109650.PubMedCrossRef
58.
Aliste J, Layera S, Bravo D, Jara Á, Muñoz G, Barrientos C, Wulf R, Brañez J, Finlayson RJ, Tran Q. Randomized comparison between pericapsular nerve group (PENG) block and suprainguinal fascia iliaca block for total hip arthroplasty. Reg Anesth Pain Med. 2021 Jul 20:rapm-2021–102997.
59.
Nakai T, Nakamura 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;10:5–7.PubMedPubMedCentralCrossRef
60.
Zoric L, Cuvillon P, Alonso S, et al. Single-shot intraoperative local anesthetic infiltration does not reduce morphine consumption after total hip arthroplasty: a double-blinded placebo-controlled randomized study. Br J Anaesth. 2014;112:722–8.PubMedCrossRef
61.
Johnson RL, Amundson AW, Abdel MO, et al. Continuous posterior lumbar plexus nerve block versus periarticular injection with ropivacaine or liposomal bupivacaine for total hip arthroplasty. J Bone Joint Surg Am. 2017;99:1836–45.PubMedCrossRef
62.••
Hirasawa N, Kurosaka K, Nishino M, et al. No clinically important difference in pain scores after THA between periarticular analgesic injection and placebo: A randomized trial. Clin Orthop Relat res. 2018;476:1837–45. This was a single center, randomized, controlled trial in patients undergoing simultaneous bilateral THA were randomly assigned to receive a periarticular injection in one hip and a placebo injection in the contralateral hip.PubMedPubMedCentralCrossRef
63.
Murphy PM, Stack D, Kinirons B, Laffey JG. Optimizing the Dose of Intrathecal Morphine in Older Patients Undergoing Hip Arthroplasty. Anesth Analg. 2003;97(6):1709–15.PubMedCrossRef
64.
Jacobson L, Chabal C, Brody MC. A dose-response study of intrathecal morphine: efficacy, duration, optimal dose, and side effects. Anesth Analg. 1988;67:1082–8.PubMedCrossRef
65.
Frauenknecht J, Kirkham KR, Jacot-Guillarmod A, Albrecht E. Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis. Anaesthesia. 2019;74:651–62.PubMedCrossRef
66.
Fawcett WJ, Jones CN. Bespoke intra-operative anaesthesia - the end of the formulaic approach. Anaesthesia. 2018;73:1062–6.PubMedCrossRef
67.
Holmberg A, Sauter AR, Klaastad Ø, Draegni T, Raeder JC. Pre-operative brachial plexus block compared with an identical block performed at the end of surgery: a prospective, double-blind, randomised clinical trial. Anaesthesia. 2017;72:967–77.PubMedCrossRef
68.
Fischer HBJ, Simanski CJP. A procedure-specific systematic review and consensus recommendations for analgesia after total hip arthroplasty. Anaesthesia. 2005;60:1189–202.PubMedCrossRef
69.
70.••
Memtsoudis SG, Corowicz C, Bekeris J, et al. Anesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the international consensus on anaesthesia-related outcomes after surgery group (ICAROS) based on a systematic review and meta-analysis. Br J Anaesth. 2019;213(3):269–87. This meta-analysis considered multiple perioperative outcomes, and the ICAROS (International consensus on anaesthesia-related outcomes after surgery) group consensus was that neuraxial anesthesia is the preferred anesthetic technique (when no contraindications exist), and that this reduces the risk of most (but not all) complications.CrossRef
Metadaten
Titel
Regional Anesthesia for Total Hip Arthroplasty: Essential Anatomy, Techniques, and Current Literature Review
verfasst von
Promil Kukreja
Lauren Mason
Joel Feinstein
S. Elizabeth Morris
Hari Kalagara
Publikationsdatum
28.09.2021
Verlag
Springer US
Erschienen in
Current Anesthesiology Reports / Ausgabe 4/2021
Elektronische ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-021-00487-w

Weitere Artikel der Ausgabe 4/2021

Current Anesthesiology Reports 4/2021 Zur Ausgabe

Pediatric Anesthesia (R Agarwal, Section Editor)

Anesthesia for Long QT Syndrome

Thoracic Anesthesia (AM Bergmann, Section Editor)

Mechanical Cardiac Circulatory Support: an Overview of the Challenges for the Anesthetist

Critical Care Anesthesia (BS Rasmussen, Section Editor)

Delirium in Intensive Care

Cardiovascular Anesthesia (J Fassl, Section Editor)

Enhanced Recovery After Cardiac Surgery: Where Do We Stand?

Thoracic Anesthesia (AM Bergmann, Section Editor)

Hypoxemia During One-Lung Ventilation: Does It Really Matter?

GERIATRIC ANESTHESIA (S AKHTAR, SECTION EDITOR)

Improving Outcomes for Elderly Patients Following Emergency Surgery: a Cutting-edge Review

Neu im Fachgebiet AINS

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Häufigste Gründe für Brustschmerzen bei Kindern

06.05.2024 Pädiatrische Diagnostik Nachrichten

Akute Brustschmerzen sind ein Alarmsymptom par exellence, schließlich sind manche Auslöser lebensbedrohlich. Auch Kinder klagen oft über Schmerzen in der Brust. Ein Studienteam ist den Ursachen nachgegangen.

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

03.05.2024 Fibromyalgiesyndrom Nachrichten

Bewegungs-, Dehnungs- und Entspannungsübungen im Wasser lindern die Beschwerden von Patientinnen mit Fibromyalgie besser als das Üben auf trockenem Land. Das geht aus einer spanisch-brasilianischen Vergleichsstudie hervor.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren
Bildnachweise