Impact of regional femoral nerve block during general anesthesia for hip arthoplasty on blood pressure, heart rate and pain control: A randomized controlled study

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Article type: Research Article

Authors: Kratz, Thomas^{a; b} | Dette, Frank^c | Schmitt, Jan^{d; e} | Wiesmann, Thomas^a | Wulf, Hinnerk^a | Zoremba, Martin^{a; *}

Affiliations: [a] Department of Anesthesia and Intensive Care Medicine, University Hospital, Philipps-University of Marburg, Marburg, Germany | [b] Department of Anesthesia and Intensive Care Medicine, Clinique Bénigne Joly, Talant, France | [c] Department of Anesthesia and Intensive Care Medicine, University Hospital, Johannes Gutenberg University, Mainz, Germany | [d] Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany | [e] Department of Orthopedics and Traumatology, Lahn-Dill-Klinikum Wetzlar, Wetzlar, Germany

Correspondence: [*] Corresponding author: Martin Zoremba, Department of Anesthesia and Intensive Care Medicine, University Hospital, Philipps-University of Marburg, Baldinger Strasse, D-35033 Marburg, Germany. Tel.: +49 6421 5861501; Fax: +49 6421 5865971; E-mail:zoremba@med.uni-marburg.de

Abstract: BACKGROUND: Adequate pain management is essential for preventing hemodynamic instability which can affect the perfusion of vital organs during the perioperative period, particularly in geriatric patients. For hip arthroplasty, peripheral nerve block is frequently used, limiting the adverse effects of opioid and non-opioid analgesics. OBJECTIVE: The aim was to survey the impact of a supplementary single shot femoral nerve block (FNB) on hemodynamic stability and pain level. METHODS: After registration at German Clinical Trial Register (DRKS-ID): DRKS00000752. and Ethics Committee approval (University Hospital of Marburg), 80 patients who underwent elective hip surgery were included. Half of them were randomly assigned to receive a FNB followed by general anesthesia; a control group received only general anesthesia as standard procedure (STD). Blood pressure and heart rate were measured and recorded every five minutes during surgery and stay at the postanesthesia care unit (PACU). RESULTS: Fifty-two patients were included for statistical analysis. The FNB group had significantly lower systolic blood pressures during and after surgery and lower diastolic blood pressure postoperatively, heart rate, as well as opioid and non-steroidal anti-inflammatory consumption. CONCLUSIONS: Femoral nerve block improved perioperative hemodynamic stability mostly likely attributable to an overall reduced sympathico adrenergic tone.

Keywords: Femoral nerve block, hip arthroplasty, hemodynamic control, postoperative analgesics

DOI: 10.3233/THC-150898

Journal: Technology and Health Care, vol. 23, no. 3, pp. 313-322, 2015