Peripheral nerve blocks for analgesia after elective total hip arthroplasty.

A significant subgroup of patients suffer from moderate or severe pain after total hip arthroplasty (THA). Regional analgesia has the potential to reduce post-operative pain and thereby spare patients from opioids, but regional analgesia of the hip is complicated as the area is innervated by multiple nerves. However, the nociceptors of the hip joint are primarily innervated by the obturator and femoral nerves. The effect of an obturator nerve block (ONB) on pain following THA has never been investigated. A femoral nerve block is known to reduce pain after THA, but is unfortunately accompanied by an increased risk of fall. We have developed a novel nerve block-the iliopsoas plane block (IPB)-that has the potential to anaesthetize the hip articular sensory branches of the femoral nerve without causing motor blockade.

An Obturator Nerve Block does not Alleviate Postoperative Pain after Total Hip Arthroplasty: a Randomized Clinical Trial.

BACKGROUND AND OBJECTIVES: A substantial group of patients suffer from moderate to severe pain following elective total hip arthroplasty (THA). Due to the complex innervation of the hip, peripheral nerve block techniques can be challenging and are not widely used. Since the obturator nerve innervates both the anteromedial part of the joint capsule as well as intra-articular nociceptors, we hypothesized that an obturator nerve block (ONB) would decrease the opioid consumption after THA. METHODS: Sixty-two patients were randomized to receive ONB or placebo (PCB) after primary THA in spinal anesthesia. Primary outcome measure was opioid consumption during the first 12 postoperative hours. Secondary outcome measures included postoperative pain score, nausea score and ability to ambulate. RESULTS: Sixty patients were included in the analysis. Mean (SD) opioid consumption during the first 12 postoperative hours was 39.9 (22.3) mg peroral morphine equivalents (PME) in the ONB group and 40.5 (30.5) mg PME in the PCB group (p=0.93). No difference in level of pain or nausea was found between the groups. Paralysis of the hip adductor muscles in the ONB group reduced the control of the operated lower extremity compared with the PCB group (p=0.026). This did, however, not affect the subjects' ability to ambulate. CONCLUSIONS: A significant reduction in postoperative opioid consumption was not found for active versus PCB ONB after THA. TRIAL REGISTRATION NUMBER: NCT03064165 and 2017-000068-14.

[Optimization of use of prehospital emergency physicians after new dispatch and guidance instructions]. / Optimeret anvendelse af laegebil efter ny disponeringsvejledning.

INTRODUCTION: Correct use of prehospital medical competence requires optimal dispatch. Based on the severity gauge Severity of Injury/Illness Index (SIII) which grades injury/illness into eight levels, we examined the effect of implementing new dispatch and guidance instructions in the emergency call centre. MATERIALS AND METHODS: From the local Prehospital Database we have withdrawn data from 1st August 2000 to 31st December 2005. On 1st August 2003 new dispatch and guidance instructions were implemented with a graded allocation of prehospital resources. It is hereby possible to dispatch 1) an ambulance + prehospital emergency physician (PEP); 2) an ambulance; or refer to 3) self care or alternative transportation. RESULTS: During the study 10,585 patients were attended by a PEP. After implementing the new dispatch and guidance instructions we experienced a total increase of five per cent in the four most severe SIII-groups. A total of 189 patients were transferred to the relevant groups. These changes are significant with p < 0,001 (chi2-test). CONCLUSION: By implementing more graded dispatch and guidance instructions in the emergency call centre it is possible to optimise the use of the PEP.