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

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An Obturator Nerve Block does not Alleviate Postoperative Pain after Total Hip Arthroplasty : a Randomized Clinical Trial. / Nielsen, Niels Dalsgaard; Runge, Charlotte; Clemmesen, Louise; Børglum, Jens; Mikkelsen, Lone Ramer; Larsen, Jens Rolighed; Nielsen, Thomas Dahl; Søballe, Kjeld; Bendtsen, Thomas Fichtner.

I: Regional Anesthesia and Pain Medicine, Bind 44, Nr. 4, 2019, s. 466-471.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

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@article{2f5b327504a5432492433cfd234131f3,
title = "An Obturator Nerve Block does not Alleviate Postoperative Pain after Total Hip Arthroplasty: a Randomized Clinical Trial",
abstract = "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.",
keywords = "ANATOMY, CARE, JOINT, OUTCOMES, TOTAL KNEE ARTHROPLASTY",
author = "Nielsen, {Niels Dalsgaard} and Charlotte Runge and Louise Clemmesen and Jens B{\o}rglum and Mikkelsen, {Lone Ramer} and Larsen, {Jens Rolighed} and Nielsen, {Thomas Dahl} and Kjeld S{\o}balle and Bendtsen, {Thomas Fichtner}",
note = "{\textcopyright} American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2019",
doi = "10.1136/rapm-2018-100104",
language = "English",
volume = "44",
pages = "466--471",
journal = "Regional Anesthesia and Pain Medicine",
issn = "1098-7339",
publisher = "LIPPINCOTT WILLIAMS & WILKINS",
number = "4",

}

RIS

TY - JOUR

T1 - An Obturator Nerve Block does not Alleviate Postoperative Pain after Total Hip Arthroplasty

T2 - a Randomized Clinical Trial

AU - Nielsen, Niels Dalsgaard

AU - Runge, Charlotte

AU - Clemmesen, Louise

AU - Børglum, Jens

AU - Mikkelsen, Lone Ramer

AU - Larsen, Jens Rolighed

AU - Nielsen, Thomas Dahl

AU - Søballe, Kjeld

AU - Bendtsen, Thomas Fichtner

N1 - © American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

KW - ANATOMY

KW - CARE

KW - JOINT

KW - OUTCOMES

KW - TOTAL KNEE ARTHROPLASTY

U2 - 10.1136/rapm-2018-100104

DO - 10.1136/rapm-2018-100104

M3 - Journal article

C2 - 30679337

VL - 44

SP - 466

EP - 471

JO - Regional Anesthesia and Pain Medicine

JF - Regional Anesthesia and Pain Medicine

SN - 1098-7339

IS - 4

ER -