Fascia Iliaca Block for Post-Operative Pain Control After Total Hip Arthroplasty

Although many improvements have been made in implant technology and surgical approaches for
total hip arthroplasty, management of post-operative pain remains a major clinical issue.
Inadequate pain control can lead to numerous unwanted side effects and limited physical
function, especially in a older population. Most surgeons have adopted a multi-modality pain
management approach using a variety of pharmaceuticals, including nerve block with local
anesthetic. In the literature, there are a number of technical variations described for the
fascia iliaca nerve block. At The Christ Hospital, Cincinnati, Ohio, anesthesiologists use a
more proximal approach to the fasica iliaca block enabling a significantly easier cephalad
spread of the local anesthetic into the pelvis targeting all three nerves; the femoral,
lateral femoral cutaneous, and the obturator.

This prospective, double-blinded, randomized, single-center study is designed to test the
primary hypothesis that fascia iliaca block with a local anesthestic decreases narcotic
consumption and provides improved pain control compared to placebo in the first 24 hours
after surgery in patients undergoing total hip arthroplasty.

Inclusion Criteria:

- anterior approach total hip arthroplasty (THA) for unilateral osteoarthritis

- English-speaking

- age 18 to 75 years

- American Society of Anesthesiologists (ASA) physical status 1 to 3

- BMI < 40 kg/m2

- Minimum weight of 50 kg.

- No contraindications to study procedures

Exclusion Criteria:

- Hip revision surgery

- Allergy to local anesthetics

- Allergy to oxycontin

- Allergy to pregabalin

- Allergy to fentanyl

- Allergy to midazolam

- Allergy to hydromorphone

- BMI > 40 kg/m2

- Chronic pre-operative opioid use