Single-Shot Psoas Compartment Blockade versus Periarticular Liposomal Bupivacaine Infiltration for Total Hip Arthroplasty
Total Hip Arthroplasty (THA) can be an extremely painful orthopedic surgical procedure that requires sufficient postoperative analgesia to allow for early mobilization with physical therapy, which may shorten the duration of hospitalization and improve patient satisfaction. This study included two groups; Group A with liposomal bupivacaine (LB) infiltration following shorter-acting psoas compartment block (SSPB), compared to Group B longer-acting psoas compartment block without periarticular infiltration. The primary endpoint was patient reported post-operative pain scores at 24 hours (Numeric Rating Scale 0-10 [NRS]). Secondary outcomes included NRS pain scores at 12, 36, and 48-hours; time to first opiate dosage; opioid consumption in the first 24 and 48 hours post-operatively; distance ambulated on post-operative day (POD) 1 and 2; and hospital length of stay (LOS) in hours.
These results suggest that analgesia after THA is equivalent with SPCB as compared to LB infiltration. Aggressive multimodal analgesia and resultant low pain scores may have made it difficult to detect a difference between the two groups. A type II error can not be ruled out. Large variability between the distances ambulated on POD1 made detection of differences between the two groups unlikely if any existed. However, patients receiving LB were discharged from the hospital more quickly than when treated with a long acting SPCB. This might have been confounded by the fact that the surgeons switched to LB in an effort to discharge patients earlier.
Materials and Methods
Primary and secondary outcomes can be found in Table 2