Analgesic Effects of Ultrasound‐Guided Iliohypogastric/Ilioinguinal Nerve Block Combined with Lateral Femoral Cutaneous Nerve Block in Total Hip Arthroplasty via Direct Anterior Approach: A Retrospective Cohort Study

Abstract

Objective This study aimed to explore the efficacy and safety of the combination of lateral femoral cutaneous nerve blocks (LFCNB) and iliohypogastric/ilioinguinal nerve blocks (IHINB) on postoperative pain and functional outcomes after total hip arthroplasty (THA) via the direct anterior approach (DAA). Methods In this retrospective cohort study, patients undergoing THA via the DAA between January 2019 and November 2019 were stratified into two groups based on their date of admission. Sixty‐seven patients received LFCNB and IHINB along with periarticular infiltration analgesia (PIA) (nerve block group), and 75 patients received PIA alone (control group). The outcomes included postoperative morphine consumption, postoperative pain assessed using the visual analogue scale (VAS), the QoR‐15 score, and functional recovery measured as quadriceps strength, time to first straight leg rise, daily ambulation distance, and duration of hospitalization. The Oxford hip score and the UCLA activity level rating were assessed at 1 and 3 months after surgery. In addition, postoperative complications were recorded. Patients were also compared based on the type of incision used during surgery (traditional longitudinal or “bikini” incision). Results Patients in the nerve block group showed significantly lower postoperative morphine consumption, lower resting VAS scores within 12 h postoperatively, lower VAS scores during motion within 24 h postoperatively, and better QoR‐15 scores on postoperative day 1. These patients also showed significantly better functional recovery during hospitalization. At 1‐month and 3‐month outpatient follow up, the two groups showed no significant differences in Oxford hip score or UCLA activity level rating. There were no significant differences in the incidence of postoperative complications. Similar results were observed when patients were stratified by type of incision, except that the duration of hospitalization was similar. Conclusion Compared to PIA alone, a combination of LFCNB and IHINB along with PIA can improve early pain relief, reduce morphine consumption, and accelerate functional recovery, without increasing complications after THA via the DAA.

Effects of Continuous Fascia Iliaca Compartment Block on Early Quality of Recovery After Total Hip Arthroplasty in Elderly Patients: A Randomized Controlled Trial

“… 23 Wang et al measured the effect of lateral femoral cutaneous nerve and iliohypogastric/ilioinguinal nerve blocks on postoperative quality of recovery at 24 and 48 h after THA; however, the clinical significance was observed only at 24 h postoperatively. 24 In our study, CFICB improved the quality of recovery only at 24 h after THA; however, it was surprising that we used continuous regional block to provide postoperative analgesia for patients, while Wang et al used only a single injection regional block. Therefore, which regional analgesic technique could significantly improve the postoperative quality of recovery for THA needs to be determined.…”

“…Some studies have investigated the influence of other regional blocks on the quality of recovery after THA using the QoR-15 score. [23][24][25] Lennon et al assessed the effect of the erector spinae plane block on the quality of recovery at 24 h after THA, and the results showed that the erector spinae plane block did not improve postoperative quality of recovery in THA. 23 Wang et al measured the effect of lateral femoral cutaneous nerve and iliohypogastric/ilioinguinal nerve blocks on postoperative quality of recovery at 24 and 48 h THA; however, the clinical significance was observed only at 24 h postoperatively.…”

Bikini Incision vs Longitudinal Incision for Anterior Total Hip Arthroplasty: A Systematic Review

“…Fourteen studies were excluded for a lack of comparison arm, irrelevance, not the bikini incision, or full texts unavailable, leaving 8 comparative studies eligible for final inclusion in this qualitative review ( Fig. 2 ) [ 9 , 12 , [16] , [17] , [18] , [19] , [20] , [21] ].

Figure 2 Preferred Reporting Items for Systematic Review and Meta-Analyses flow diagram.

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“…The included studies reported a total of 2313 patients that underwent DAA THA using a bikini (n = 952) vs longitudinal incision (n = 1361). Seven studies reported mean age and sex proportion; in the bikini incision group, mean patient age ranged from 54.3 [ 20 ] to 70 [ 12 ] years, and the majority of reported patients were female (550/952; 57.8%). In the longitudinal incision group, the mean patient age ranged from 55 [ 20 ] to 67.4 [ 18 ] years, and the majority of reported patients were female (620/1132; 54.8%).…”

“…Seven studies reported mean age and sex proportion; in the bikini incision group, mean patient age ranged from 54.3 [ 20 ] to 70 [ 12 ] years, and the majority of reported patients were female (550/952; 57.8%). In the longitudinal incision group, the mean patient age ranged from 55 [ 20 ] to 67.4 [ 18 ] years, and the majority of reported patients were female (620/1132; 54.8%). Mean BMI data were available in 6 studies and ranged from 23.2 [ 16 ] to 25.6 [ 9 ] in the bikini group and from 23.8 [ 20 ] to 28 [ 12 ] in the longitudinal group.…”