• F J Singelyn and J M Gouverneur.
• Department of Anesthesiology, Catholic University of Louvain School of Medicine, Brussels, Belgium. singelyn@anes.ucl.ac.be
• J Clin Anesth. 1999 Nov 1;11(7):550-4.

Study ObjectiveTo assess the most appropriate postoperative analgesic technique after hip surgery.DesignProspective, nonrandomized study.SettingUniversity hospital.Patients1,338 ASA physical status I, II, and III patients scheduled for elective unilateral total hip arthroplasty (THA).InterventionsDuring the first 48 postoperative hours, pain relief was provided by intravenous (i.v.) patient-controlled analgesia (PCA) with morphine (Group 1), continuous "3-in-1" block (Group 2), or patient-controlled epidural analgesia (PCEA) (Group 3).Measurements And Main ResultsDuring a 7.5-year period, pain scores, supplemental analgesia, satisfaction score, technical problems, and side effects were collected by our acute pain service. Postoperative pain relief was comparable in the three groups. More paracetamol was required in Group 2 (1.0 +/- 1.2 g/48 h) and Group 3 (0.9 +/- 1.3 g/48 h) than in Group 1 (0.5 +/- 1.1 g/48 h) (p < 0.01). However, only 8% of patients in Group 2 and 12% of patients in Group 3 needed an opioid. A higher incidence of technical problems was noted in Group 3 (23.4%) than in Group 1 (2.3%) or Group 2 (5.5%) (p < 0.001). A lower incidence of side effects was observed in Group 2 (23.5%) when compared with Group 1 (58.8%) and Group 3 (71.9%) (p < 0.001). Satisfaction score was significantly higher in Group 2 than in the other two groups [80 +/- 16 vs. 87 +/- 14 vs. 81 +/- 14 in Groups 1, 2, and 3 respectively (p = 0.003)].ConclusionAfter THA, i.v. PCA with morphine, continuous "3-in-1" block, and PCEA provided comparable pain relief. Because it induces the fewest technical problems and side effects, continuous "3-in-1" block is the preferred technique.

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