A randomized controlled trial of iliopsoas plane block vs. femoral nerve block for hip arthroplasty

Abstract

Background: Iliopsoas plane block (IPB) is a novel analgesic technique for hip surgery that retains quadriceps strength. However, evidence from randomized controlled trial is remains unavailable. We hypothesized that IPB, as a motor-sparing analgesic technique, could match the femoral nerve block (FNB) in pain management and morphine consumption, providing an advantage for earlier functional training in patients underwent hip arthroplasty.

Methods: We recruited ninety patients with femoral neck fracture, femoral head necrosis or hip osteoarthritis who were scheduled for unilateral primary hip arthroplasty were recruited and received either IPB or FNB. Primary outcome was the pain score during hip flexion at 4 h after surgery. Secondary outcomes included quadriceps strength and pain scores upon arrival at post anesthesia care unit (PACU) and at 2, 4, 6, 24, 48 h after surgery, the first time out of bed, total opioids consumption, patient satisfaction, and complications.

Results: There was no significant difference in terms of pain score during hip flexion at 4 h after surgery between the IPB group and FNB group. The quadriceps strength of patients receiving IPB was superior to those receiving FNB upon arrival at PACU and at 2, 4, 6 and 24 h after surgery. The IPB group showed a shorter first time out of bed compared to the FNB group. However, there were no significant differences in terms of pain scores within 48 h after surgery, total opioids consumption, patient satisfaction and complications between the two groups.

Conclusion: IPB was not superior to FNB in terms of postoperative analgesia for hip arthroplasty. However, IPB could serve as an effective motor-sparing analgesic technique for hip arthroplasty, which would facilitate early recovery and rehabilitation. This makes IPB worth considering as an alternative to FNB.

Trial registration: The trial was registered prior to patient enrollment at the Chinese Clinical Trial Registry (ChiCTR2200055493; registration date: January 10, 2022; enrollment date: January 18, 2022; https://www.chictr.org.cn/searchprojEN.html ).

Keywords: Femoral nerve block; Hip arthroplasty; Iliopsoas plane block.

Fig. 1

Iliopsoas Plane Block (a) and Femoral Nerve Block (b). Sa represents the Sartorius muscle, RF represents the Rectus Femoris muscle, IP represents the Iliopsoas muscles, and HoF represents the Head of Femur. The white asterisk indicates the Iliofemoral ligament, FN represents the Femoral Nerve, “A” represents the Femoral Artery, and the white arrow shows the needle trajectory of the nerve block

Fig. 2

Study Flow Diagram. IPB represents the Iliopsoas Plane Block, and FNB represents the Femoral Nerve Block. This diagram provides a detailed representation of the number of patients initially recruited, those excluded, and those ultimately included in the study