ĐÁNH GIÁ HIỆU QUẢ GIẢM ĐAU SAU PHẪU THUẬT KHỚP HÁNG CỦA PHƯƠNG PHÁP GÂY TÊ KHOANG MẠC CHẬU DƯỚI HƯỚNG DẪN CỦA SIÊU ÂM

Abstract

Background: Hip replacement is a common surgery at the University Medical Center Ho Chi Minh City, with 232 cases performed in 2022, 259 cases performed in 2023 and 167 casess in the first 6 months of 2024. Postoperative pain typically ranges from moderate to severe, affecting recovery and increasing the risk of complications. Therefore, postoperative pain management is crucial for both patient comfort and the success of the surgery. Currently, in addition to traditional pain relief methods such as oral medications, intravenous analgesics, and epidural analgesia, ultrasound-guided regional anesthesia techniques, notably the Fascia Iliaca Compartment Block (FICB), are also applied. FICB is favored for its ease of administration, low complication rates, and effectiveness in reducing pain after hip replacement surgery. This study was conducted to demonstrate the analgesic effectiveness of FICB and provide an additional option for postoperative pain management in hip surgeries. Objective: The main objective is to evaluate the analgesic effectiveness of FICB by measuring the reduction in opioid consumption within the first 24 hours after hip replacement surgery. Secondary objective: To compare the VAS pain scores at rest and during movement (leg lift) between the intervention group and the control group. Methods: This randomized controlled clinical trial was conducted on 36 patients undergoing hip replacement surgery. Patients who consented to participate were randomly assigned to the intervention or control groups. At the end of surgery, the intervention group received a single dose of 30ml 0.2% ropivacaine via FICB, while the control group did not. Both groups received 1g paracetamol and 20mg nefopam intravenously every 8 hours postoperatively, and PCA morphine, bolus 1mg, lockout 8 minutes, and a maximum of 24mg/4 hours. Pain levels, using VAS scores, total morphine consumption within the first 24 hours, and opioid-related side effects (sedation, nausea, vomiting, urinary retention) were recorded at 1, 4, 8, 12, and 24 hours postoperatively. Results: FICB reduced opioid consumption by 54% within the first 24 hours postoperatively, which was statistically significant (p < 0.001). The VAS pain scores at rest in the intervention group were significantly lower than the control group at 1, 4, 8, and 24 hours (p-value < 0.05), with no difference at 12 hours. The VAS pain scores during movement (leg lift) in the intervention group were lower at 1 and 8 hours postoperatively compared to the control group. Conclusion: FICB reduced morphine consumption by 54% in the first 24 hours after hip replacement surgery, while also lowering resting VAS scores in the first 24 hours and movement-related pain within the first 8 hours. We found that the fascia iliaca compartment block can be applied for postoperative pain relief in hip replacement surgery as it is an effective and safe analgesic method.