Femoralis-Katheter versus Fascia iliaca compartment Katheter nach Hüftgelenks-Endoprothesen: Welches Verfahren ist die bessere Alternative bezüglich postoperativer Analgesie und Funktionalität?

A. Problematik Durch die räumliche Nähe von Nerven und Gefäßen in der Leistenregion ist die Gefahr einer Verletzung derselben beim Femoralis-Block (FEM) erhöht. Auch durch die Verwendung von Stimulationskathetern kann eine Nervenverletzung nicht sicher ausgeschlossen werden. Seit 1990 gibt es ein w...

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Bibliographic Details
Main Author: Benthaus, Sabine
Contributors: Ruchholtz, Steffen (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2010
Online Access:PDF Full Text
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BACKROUND: The efficacy of analgesia and the functional outcome of continuous femoral nerve (FEM) and fascia iliaca compartment blocks (FICB) were compared. METHODS: Eighty patients scheduled for total hip replacement were intended for this prospective trial and were randomly divided into two groups. Before surgery with the patients anesthetized, catheters were placed for continuous FEM by means of a nerve stimulator (group 1). In group 2, the catheter was inserted for continuous FICB without nerve stimulator but with a blunt 45° shape needle. In both groups, a 500mg prilocaine bolus was administered followed by continuous infusion of 10ml/h of 0.2% ropivacaine for 24 hours. In the postoperative period, both groups received enteral diclofenac 3x50mg and intravenous patient-controlled piritramid as rescue analgesia if the visual analog scale (VAS 0-10cm) pain values were greater than 3cm. In case of renal failure or other contraindications of diclofenac, the patients received instead of diclofenac metamizol 2,5g. 24h piritramid consumption, VAS 0-10cm pain values during the first three postoperative days and the functional outcome during the first three months post-operative (by means of neutral-0-method and questionnaires as harris hip score, lequesne index, WOMAC index and sf-36) were recorded. RESULTS: The patients of group 2 required more piritramid (in the median 15,0mg) than the patients of group 1 (in the median 24,8mg), but the difference was not significant (p = 0,26). No significant differences were observed between groups regarding VAS pain values and functional outcome. No major side effects were observed. CONCLUSION: This study suggests that FEM and FICB provide comparable effective pain relief and allow similar functional outcome after total hip arthroplasty. As patients with continuous FEM required less additional piritramid, it appears to offer the better option. No severe side effects were recorded.