Influence of pain relief management on early patents rehabilitation after total hip replacement

Vitaliy Kolomachenko


Adequate pain relief after total hip replacement can promote to decrease chronic pain, to improve muscles function and to increase joints movements.

Objective: to compare different methods of pain management with scores of pain reduction and physical activity after total hip replacement.

Methods: 150 patients were included into the study, patients average age (63,3 ± 12,5) years old after total hip replacement. 4 methods of anesthesia were used: general (group G , n = 25), paravertebral block in combination with caudal epidural anesthesia (group PVE, n = 25), spinal anesthesia (group S , n = 75), pe­ripheral nerve blocks (group NB = 25). After surgery patients got a nesthesia: systemic opiods (group O , n = 75), paravertebral block (group PV, n = 50), epidural anesthesia (group E, n = 25). We estimated the time which was needed to get the next three criteria: adequate pain relief (pain intensity less than 4 according to VAS), without injections of opoids more than during 12 hours, ability to walk distance of 30 m.

Results: patients from the group G took much more time (61,2 ± 23,5) hours to get three criteria after surgery comare with group PVE — (40,8 ± 17,1) hours, р = 0.0009; S — ( 48,6 ± 19,3) hours, р = 0.009; NB — (47,6 ± 15,1) hours, р = 0,02. In the group PVE we have got the best recovery result after operation. Patients of the group PV have to take significantly less time to get three criteria after surgery (38,4 ± 14,8) hours compare with group O — (56,2 ± 20,6) hours, p = 0.000001; E — (50.0 ± 17.4) hours, р = 0.003.

Conclusions: prolong paravertebral anesthesia can improve postoperative course and provide better conditions for physical patient’s recovery after total hip replacement.


hip replacement; anesthesia; analgesia; rehabilitation


Learmonth, I. D., Young, C., & Rorabeck, C. (2007). The operation of the century: total hip replacement. The Lancet, 370(9597), 1508-1519. doi:10.1016/s0140-6736(07)60457-7

Shan, L., Shan, B., Graham, D., & Saxena, A. (2014). Total hip replacement: a systematic review and meta-analysis on mid-term quality of life. Osteoarthritis and Cartilage, 22(3), 389-406. doi:10.1016/j.joca.2013.12.006

Ranawat, A. S., & Ranawat, C. S. (2007). Pain management and accelerated rehabilitation for total hip and total knee arthroplasty. The Journal of Arthroplasty, 22(7), 12-15. doi:10.1016/j.arth.2007.05.040

Johnson, R., Kopp, S., Burkle, C., Duncan, C., Jacob, A., Erwin, P., … Mantilla, C. (2016). Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. British Journal of Anaesthesia, 116(2), 163-176. doi:10.1093/bja/aev455

Horlocker, T. T., Kopp, S. L., Pagnano, M. W., & Hebl, J. R. (2006). Analgesia for Total Hip and Knee Arthroplasty: A Multimodal Pathway Featuring Peripheral Nerve Block. Journal of the American Academy of Orthopaedic Surgeons, 14(3), 126-135. doi:10.5435/00124635-200603000-00003

Greimel, F., Maderbacher, G., Zeman, F., Grifka, J., Meissner, W., & Benditz, A. (2017). No clinical difference comparing general, regional, and combination anesthesia in hip arthroplasty: a multicenter cohort-study regarding perioperative pain management and patient satisfaction. The Journal of Arthroplasty, 32(11), 3429-3433. doi:10.1016/j.arth.2017.05.038

Shan, L., Shan, B., Graham, D., & Saxena, A. (2014). Total hip replacement: a systematic review and meta-analysis on mid-term quality of life. Osteoarthritis and Cartilage, 22(3), 389-406. doi:10.1016/j.joca.2013.12.006

Demirel, I., Ozer, A. B., & Duzgol, O. (2014). Comparison of unilateral spinal anesthesia and LІ paravertebral block combined with psoas compartment and sciatic nerve block in patients to undergo partial hip prosthesis. European Review for Medical and Pharmacological Sciences, 18(7), 1067–1072.

Parvizi, J. (2007). The merits of regional anesthesia for patients undergoing total hip replacement. American journal of orthopedics, 36(7),E100.

Jakobsson, J., & Johnson, M. Z. (2016). Perioperative regional anaesthesia and postoperative longer-term outcomes. F1000Research, 5, 2501. doi:10.12688/f1000research.9100.1

Olczak, B., Kowalski, G., Leppert, W., Bienert, A., Teżyk, A., Adamski, M., … Wieczorowska-Tobis, K. (2017). Analgesic efficacy and safety of epidural oxycodone in patients undergoing total hip arthroplasty: a pilot study. Journal of Pain Research, 10, 2303-2309. doi:10.2147/jpr.s144799

Kehlet, H., & Aasvang, E. K. (2015). Regional or general anesthesia for fast-track hip and knee replacement - what is the evidence? F1000Research. doi:10.12688/f1000research.7100.1

Singelyn, F. J., Ferrant, T., Malisse, M. F., & Joris, D. (2005). Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty. Regional Anesthesia and Pain Medicine, 30(5), 452-457. doi:10.1097/00115550-200509000-00006

Becchi, C., Al Malyan, M., Coppini, R., Campolo, M., Magherini, M., & Boncinelli, S. (2008). Opioid-free analgesia by continuous psoas compartment block after total hip arthroplasty. A randomized study. European Journal of Anaesthesiology, 25(5), 418-423. doi:10.1017/s026502150700302x

Copyright (c) 2018 Vitaliy Kolomachenko

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.