Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Anesthesiol. May 10, 2019; 8(2): 13-18
Published online May 10, 2019. doi: 10.5313/wja.v8.i2.13
Enhanced recovery after surgery pathway: The use of fascia iliaca blocks causes delayed ambulation after total hip arthroplasty
Jamie-Lee Metesky, Junping Chen, Meg Rosenblatt
Jamie-Lee Metesky, Junping Chen, Meg Rosenblatt, Anesthesia Department, Mount Sinai St. Luke’s and West Hospitals, New york, NY 10019, United States
Author contributions: All the authors solely contributed to this paper.
Institutional review board statement: The study was reviewed and approved for publication by the Mount Sinai Institutional Review Board.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original encrypted dataset is available on request from the author Jamie Metesky at jmetesky@mountsinai.org.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Junping Chen, Associate Professor, MD, PhD, Department of Anesthesiology, Mount Sinai St. Luke’s and West Hospitals, 1000 10th Avenue, New York, NY 10019, United States. junping.chen@mountsinai.org
Telephone: +1-212-5236121
Received: October 31, 2018
Peer-review started: October 31, 2018
First decision: November 8, 2018
Revised: March 7, 2019
Accepted: March 24, 2019
Article in press: March 25, 2019
Published online: May 10, 2019
Abstract
BACKGROUND

Fascia iliaca compartment blocks (FIBs) have been used to provide postoperative analgesia after total hip arthroplasty (THA). However, evidence of their efficacy remains limited. While pain control appears to be satisfactory, quadriceps weakness may be an untoward consequence of the block. Prior studies have shown femoral nerve blocks and fascia iliaca blocks as being superior for pain control and ambulation following THA when compared to standard therapy of parenteral pain control. However, most studies allowed patients to ambulate on post-operative day (POD) 2-3, whereas new guidelines suggest ambulation on POD 0 is beneficial.

AIM

To determine the effect of FIB after THA in patients participating in an enhanced recovery after surgery (ERAS) program.

METHODS

We conducted a retrospective analysis of patients undergoing THA with or without FICBs and their ability to ambulate on POD 0 in accordance with ERAS protocol. Perioperative data was collected on 39 patients who underwent THA. Demographic data, anesthesia data, and ambulatory outcomes were compared.

RESULTS

Twenty patients had FIBs placed at the conclusion of the procedure, while 19 did not receive a block. Of the 20 patients with FIB, only 1 patient was able to ambulate. Of the 19 patients without FIB blocks, 17 were able to ambulate. All patients worked with physical therapy 2 h after arriving in the post-anesthesia care unit on POD 0.

CONCLUSION

Our data suggests an association between FIB and delayed ambulation in the immediate post-operative period.

Keywords: Fascia iliaca, Total hip arthroplasty, Enhanced recovery after surgery protocol, Deep vein thrombus, Post-operative

Core tip: We evaluated the ambulatory ability of total hip arthroplasty patients in the immediate post-operative period to determine if there was an association with the use of fascia iliaca blocks and hindered ambulatory ability. We observed that in accordance with enhanced recovery after surgery protocol, which requires patients to ambulate on POD 0, there was an association with fascia iliaca block and delayed ambulation.