A nerve block should be co-administered with general anaesthesia (femoral, fascia iliaca, psoas compartment block or local anaesthesia infiltration).

 

Rationale

Co-administration of a nerve block

  • reduces age-adjusted maintenance doses of general anaesthesia
  • reduces opioid analgesia requirements postoperatively [45]

 

Compared to fascia iliaca and femoral nerve block, psoas compartment block more reliably anaesthetises the lateral cutaneous nerve of the thigh (ie where hip fracture incisions are made) [46]

The hip joint is innervated postero-inferiorly by braches of the sciatic nerve, and so additional analgesia (eg local anaesthesia infiltration) may be required for total hip replacement.

The effectiveness of local anaesthesia infiltration is operator-dependant.

 

Evidence

1. Parker MJ, Griffiths R, Appadu BN. Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database of Systematic Reviews 2002; 1: CD001159.

2. Mannion S. Psoas compartment block. Continuing Education in Anaesthesia, Critical Care and Pain 2007; 7: 162-6.