Postoperative analgesia with "3-in-1" femoral nerve block after prosthetic hip surgery

Purpose: To evaluate the efficacy of a single shot "3-in-1" femoral nerve block for prosthetic hip surgery in association with general anaesthesia on post-operative analgesia. Methods: Forty patients, ASA 1 to 3, received sham block or "3-in-1" femoral nerve block,following Winnie's landmarks with a nerve stimulator, and 40 mi bupivacaine 0.5% with epinephrine were injected after induction of anaesthesia. Vecuronium, 0.1 mg . kg(-1), was added after performing the block and anaesthesia was maintained with isoflurane, oxygen 40% and nitrous oxide 60%. Fentanyl, 1.5 mu g . kg(-1), was administered before;re incision to-ail patients. Heart rate, blood pressure, fentanyl requirements and F(ET)iso were measured throughout surgery, During the post-operative period, 75 mg diclofenac im and/or 0.1 mg . kg(-1) morphine sc were administered when pain score was > 3/10 and repeated when necessary, Pain scores at first analgesic intervention, at 24 hr and 48 hr as well as didofenac and morphine requirements after surgery were recorded, Results: There was no difference in anaesthetic requirements during surgery, The time from performance of sham or "3-in-1" femoral nerve block to the first analgesic intervention (261 +/- 49 min versus 492 +/- 40 min, P < 0.05) and time from extubation to the first analgesic intervention (61 +/- 44 min vs 298 +/- 39 min, P < 0.05) were prolonged in the study group, However, pain scores and the analgesic requirements in the postoperative periods (24 and 48 hr) were similar. Conclusion: There is a short-term benefit during the first few postoperative hours in using a single shot "3-in-1" femoral nerve block to complement general anaesthesia for elective hip surgery.