• Philippe Biboulet, Didier Morau, Pierre Aubas, Sophie Bringuier-Branchereau, and Xavier Capdevila.
• Department of Anesthesiology and Critical Care, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France. p-biboulet@chu-montpellier.fr
• Reg Anesth Pain Med. 2004 Mar 1; 29 (2): 102-9.

BackgroundThe authors compared the analgesic effects and quality of rehabilitation of three analgesic techniques after total-hip arthroplasty in a double-blind, randomized trial.MethodsForty-five patients were assigned to 1 of 3 groups, patient-controlled analgesia with morphine (PCA), femoral nerve block (FNB), or psoas compartment block (PCB). At the end of the procedure performed under general anesthesia, nerve blocks using 2 mg/kg of 0.375% bupivacaine and 2 microg/kg of clonidine were performed in the FNB (n = 16) and PCB (n = 15) groups. In the recovery room, all 3 groups received initial intravenous morphine titration if their pain score was higher than 30 on a 100-mm visual analog scale (VAS), and then a PCA device was initiated. Morphine consumption was the primary end point to assess postoperative analgesia.ResultsAfter extubation (H0), morphine titration was higher in the PCA group (P <.05). During the first 4 postoperative hours (H0 to H4), morphine consumption per hour and VAS pain score were lower in the PCB group (P <.05). After H4, there was no difference in morphine consumption and VAS among groups, either at rest or during mobilization. After H4, morphine consumption remained lower than 0.5 mg/h, and VAS remained lower than 30 mm in the 3 groups. In 4 patients of the PCB group, an epidural diffusion was noted. Hip mobility and length of stay in the rehabilitation center were not different among the groups.ConclusionsPCA is an efficient and safe analgesia technique. FNB and PCB should not be used routinely after total-hip arthroplasty.

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