Clinical Study Of Multimodal Analgesia For Total Hip Arthroplasty

ObjectiveTotal hip arthroplasty is one of the treatments for severe hip disease, pain relief and reconstruction of joint function.75% of patients will suffer acute pain, caused mainly by surgical trauma. The pain may not only affect the effect of operation and postoperative rehabilitation exercises, but cause cardiovascular, respiratory, digestive, urinary, endocrine and metabolic alteration, leading to immunity weakened, even further to psychological changes.This study aim at observing the efficacy and safety based on patient-controlled epidural analgesia, combining with either ultrasound guided fascia iliaca compartment block or transcutaneous electrical acupoint stimulation after total hip replacement.MethodsThis study was a randomized, controlled trial.59 patients from September 2014 to October 2015 met the inclusion criteria undergoing total hip arthroplasty selected.The patients were randomly divided into four groups by extracting the non transparent sealed envelope:controlled group(C group), ultrasound guided fascia iliaca compartment block group (F group), transcutaneous electrical acupoint stimulation group (T group) and ultrasound guided fascia iliaca compartment block plus transcutaneous electrical acupoint stimulation group (FT group). All patients received combined spinal-epidural anesthesia(CSEA) and patient controlled epidural analgesia pump(PCEA). F and FT group received ultrasound guided fascia iliaca compartment block(FICB) after finished CSEA. T group adjusted appropriate stimulus intensity before CSEA, and start electrical stimulation after changed to supine position. T and FT group carried out TEAS on 12 and 24 hours after surgery.We observed 24h consumption of analgesia drug, 1h,2h,4h,8h,12h,24h, 48h VAS score at rest, excellent rate of analgesic effect, additional analgesics usage of 2 days after surgery, complications (nausea, vomiting, itching, hypotension, respiratory depression and other), sleep quality and patient satisfaction.Result1. 1h,2h,4h,8h,12h,24h,48h VAS score at rest of 4 groups was no significant difference, P>0.05.2. The excellent rate of analgesic effect of fascia iliaca compartment block plus transcutaneous electrical acupoint stimulation group was higher than control group(75%vs 87%).3.The incidence of vomiting of T, FT group was significantly lower than that of the control group, P<0.05. Incidence of nausea, itching, urinary retention were not statistically significant difference, P>0.05. No adverse reactions such as hypotension, respiratory depression and other adverse reactions occurred in this experiment.4.Sleep quality and patient satisfaction after 2 days of operation was no significant difference, P>0.05.ConclusionThe analgesic way of ultrasound guided fascia iliaca compartment block composite transcutaneous electrical acupoint stimulation can compensate for incomplete analgesia of PCEA, and reduce the incidence of postoperative complications effectively. It is clinically practical on patient comfort and rehabilitation.