Comparison of combined lumbar and PIP block versus general anesthesia on postoperative outcomes in hip surgery

• Published in: Perioperative care and operating room management Vol. 32; p. 100320
• Main Authors: Ye, Yingchao, Papadimos, Thomas J., Xia, Yun, Wang, Quanguang
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2023
• Subjects: Anesthesia type; Hip surgery; Outcomes; Sacral plexus block; Anesthesia type; Sacral plexus block; Hip surgery; Outcomes
• ISSN: 2405-6030; 2405-6030
• DOI: 10.1016/j.pcorm.2023.100320

•Hip fractures have a significant negative impact on everyday activities and life quality.•The parasacral ischial plane (PIP) block is a novel fascial plane approach to the sacral plexus.•The ultrasound-guided lumbar plexus block accompanied by the PIP block resulted in satisfactory intraoperative and postoperative conditions. To verify the clinical feasibility of parasacral ischial plane (PIP) block in hip surgery, we conducted a randomized controlled trial comparing the effects of combined lumbar and PIP block and general anesthesia on patient pain and outcomes. Randomized controlled trial. Operating room. 60 participating patients scheduled for elective total hip arthroplasty. All patients were divided into two groups. The first group (n=30) received general anesthesia, and the second group, the LPIP group (n=30), received a combined lumbar and parasacral ischial plane block. Postoperative outcomes were investigated using Shapiro–Wilk test, X2 test and mixed model accounting. The primary outcome was total intravenous patient control analgesia (PCA) pump consumption of sufentanil in the first 24 h. Secondary outcomes included pain scores at 3, 6, 12, and 24 h after surgery; time to rehabilitation placement; hospital length of stay; and postoperative nausea and vomiting. There was significant difference in the postoperative 24-hour PCA pump consumption of sufentanil (general anesthesia group, median [interquartile range], 74 [66 to 87] μg versus LPIP group, 65 [57 to 72] μg; median difference, 12; 95% CI, 4 to 19; P =0.004). The pain scores (rest or movement) at 3h and 6h after surgery were significantly different between the two groups (p<0.001). There was no statistical difference between the two groups in time to rehabilitation placement (median difference, 1.3; 95% CI, 22.5 to 27.5; P = 0.155), hospital length of stay, and postoperative nausea and vomiting. The LPIP block facilitates comfortable and uneventful hip surgery, reduces the PCA consumption of sufentanil, and does not affect the postoperative recovery time.