LOCAL ANAESTHETIC NERVE BLOCK IN THE TREATMENT OF INTRACTABLE PAIN FROM OSTEOARTHRITIS OF THE HIP*

Previous workers have advocated hip nerve block, with local anaesthetic, in the treatment of intractable pain from osteoarthritis of the hip. In a pilot study we obtained some degree of pain relief in only six of 13 patients. A further double-blind, controlled, randomized trial was under-taken in 31 patients, comparing 0.5 % Marcain and normal saline. There was no significant improvement in pain or hip movements in either group over a six-week period. OBTURATOR neurectomy (Camitz, 1933), together with resection of the nerve to quadratus femoris (Tavernier, 1948), was used as a treatment of the painful osteoarthritic hip. Results varied from 83 % with complete relief for up to six months (Liebolt, Beal and Speer, 1950) to only 18 % when followed up for three to nine years (Sander, 1964). Hip replacement arthroplasty has become an accepted form of treatment now, but in the small group of patients in whom surgery is unsuitable, local anaesthetic hip nerve blocks have been advocated. Procaine injections for control of pain in the arthritic hip were first used by Ergen-bright and Lowry (1949). Recently, James and Little (1976) reported an open study in which 26 of 40 patients with osteoarthritis of the hip obtained good or complete relief of pain. In a pilot study we obtained some degree of pain relief in only six of 13 patients when followed up for six weeks. To evaluate a possible placebo response we undertook a further controlled trial and this paper presents our experience in 31 patients