Effects Of Nerve Block And Local Infiltration On Pain And Quality Of Life After Total Hip Arthroplasty In Middle-aged And Elderly Patients

ObjectivePatients usually suffered from moderate to severe pain after total hip arthroplasty(THA).Studies had shown that both lumbosacral plexus block and local infiltration analgesia could effectively relieve acute postoperative pain.Therefore,in this study,we observed the differences in the impact of these two different analgesic methods on the postoperative pain and quality of life after total hip arthroplasty in middle-aged and elderly patients.Methods1.Study objects and groups: A total of 117 patients who were selected for THA in our hospital were randomly divided into Group LSPB(general anesthesia plus lumbosacral plexus block,n=61)and Group LIA(general anesthesia plus local infiltration analgesia,n=56).2.Anesthetic method: Both groups of patients received total intravenous general anesthesia.In the LSPB group,lumbosacral plexus block was guided by ultrasound combined with a nerve stimulator before induction of general anesthesia.A total of 40 ml 0.5% ropivacaine were administrated for lumbar plexus and sacral plexus block.Before the end of the surgery,patients in the LIA group received the local infiltration analgesia by injecting 40 ml 0.5% ropivacaine in multiple points around the joint capsule and the incision.3.Outcome measures:3.1 primary outcome measures: The patient's overall pain score(numerical rating scale,NRS)in the first 72 postoperative hours.Patients' Euro Qol five-dimension questionnaire(EQ-5D)scores were recorded at one day,three days,seven days,one month,three months,and six months after surgery.The EQ-5D scale includes five dimension: Mobility,Self-Care,Usual Activities,Pain/Discomfort,and Anxiety/ Depression.3.2 Secondary outcome measures: The cumulative consumption of postoperative opioids,and the incidence of postoperative nausea and vomiting in the first 72 postoperative hours were recorded.The incidence of postoperative pain was recorded at one day,three days,seven days,one month,three months,and six months after surgery(calculated from the Pain/Discomfort part of the EQ-5D scale).The incidence of delirium was recorded in the first three days after surgery.The incidence of postoperative cognitive dysfunction was recorded at one day,three days,seven days,one month,three months,and six months after surgery.ResultsThere were no significant differences in general information such as gender,age,education level between the two groups of patients.The consumption of propofol,sufentanil,and remifentanil in the LSPB group was significantly lower than that in the LIA group(P <0.05).Primary outcome measures: Group LSPB patients had lower NRS scores than Group LIA patients within 12 hours post-surgery.Within 12–24 h and 24–48 h post-surgery,NRS scores were higher in Group LSPB(P <0.05).The EQ-5D scores of patients in the LSPB group were significantly higher than those in the LIA group within six months postoperatively,especially within the first month.(P <0.05).Secondary outcome measures: No differences were observed in the opioid consumption and the incidence of postoperative nausea and vomiting between the groups up to 72 hours post-surgery.More patients reported severe pain in the LSPB group than in the LIA group on the first postoperative day.Fewer patients reported postoperative pain in the LSPB group than that in the LIA group in the first month(P <0.05).The difference in the incidence of postoperative pain between the two groups in the other periods was not statistically significant.Fewer patients in the LSPB group had severe problems in mobility on seventh day after surgery.In the LSPB group,more patients had no problems in mobility,and fewer patients had moderate problems in mobility in the first month.In the LSPB group,more patients had no problems in mobility,and fewer patients had severe problems in mobility than in the LIA group in the third month.The difference in the incidence of postoperative delirium and postoperative cognitive dysfunction between the two groups was not statistically significant.ConclusionFor patients receiving total hip arthroplasty,both the lumbosacral plexus block and local infiltration analgesia provide satisfactory pain relief in the 48 h after surgery.The lumbosacral plexus block reduces the intraoperative need for opioids,lowers the incidence of postoperative pain in the first month after surgery,and improves patients' quality of life within six months after surgery.