278: Comparison of Epidural Anaesthesia With Continuous Lumbar Plexus Block for Total Hip Arthroplasty

2008 ◽  
Vol 33 (5) ◽  
pp. e155-e155
Author(s):  
N MARSHALL ◽  
S WATTS
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Epidural Anaesthesia ◽  
Lumbar Plexus ◽  
Total Hip ◽  
Lumbar Plexus Block ◽  
Plexus Block

Continuous Lumbar Plexus Block for Postoperative Pain Control After Total Hip Arthroplasty

2009 ◽  
Vol 91 (1) ◽  
pp. 29-37 ◽  
Author(s):  
Joseph Marino ◽  
Joseph Russo ◽  
Maureen Kenny ◽  
Robert Herenstein ◽  
Elayne Livote ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Pain Control ◽  
Lumbar Plexus ◽  
Postoperative Pain Control ◽  
Total Hip ◽  
Lumbar Plexus Block ◽  
Plexus Block

Lumbar Plexus Block Reduces Pain and Blood Loss Associated with Total Hip Arthroplasty

2000 ◽  
Vol 93 (1) ◽  
pp. 115-121 ◽  
Author(s):  
Robert D. Stevens ◽  
Elisabeth Van Gessel ◽  
Nicolas Flory ◽  
Roxane Fournier ◽  
Zdravko Gamulin
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
General Anesthesia ◽  
Hip Arthroplasty ◽  
Lumbar Plexus ◽  
Control Group ◽  
Total Hip ◽  
Pain Scores ◽  
Lumbar Plexus Block ◽  
Plexus Block

Background The usefulness of peripheral nerve blockade in the anesthetic management of hip surgery has not been clearly established. Because sensory afferents from the hip include several branches of the lumbar plexus, the authors hypothesized that a lumbar plexus block could reduce pain from a major hip procedure. Methods In a double-blind prospective trial, 60 patients undergoing total hip arthroplasty were randomized to receive general anesthesia with (plexus group, n = 30) or without (control group, n = 30) a posterior lumbar plexus block. The block was performed after induction using a nerve stimulator, and 0.4 ml/kg bupivacaine, 0.5%, with epinephrine was injected. General anesthesia was standardized, and supplemental fentanyl was administered per hemodynamic guidelines. Postoperative pain and patient-controlled intravenous morphine use were serially assessed for 48 h. Results The proportion of patients receiving supplemental fentanyl intraoperatively was more than 3 times greater in the control group (20 of 30 vs. 6 of 29, P = 0.001). In the postanesthesia care unit, a greater than fourfold reduction in pain scores was observed in the plexus group (visual analogue scale [VAS] pain score at arrival 1.3 +/- 2 vs. 5.6 +/- 3, P < 0.001), and "rescue" morphine boluses (administered if VAS > 3) were administered 10 times less frequently (in 2 of 28 vs. in 22 of 29 patients, P < 0.0001). Pain scores and morphine consumption remained significantly lower in the plexus group until 6 h after randomization (VAS at 6 h, 1.4 +/- 1.3 vs. 2.4 +/- 1.4, P = 0.007; cumulative morphine at 6 h, 5.6 +/- 4.7 vs. 12.6 +/- 7.5 mg, P < 0.0001). Operative and postoperative (48 h) blood loss was modestly decreased in the treated group. Epidural-like distribution of anesthesia occurred in 3 of 28 plexus group patients, but no other side-effects were noted. Conclusions Posterior lumbar plexus block provides effective analgesia for total hip arthroplasty, reducing intra- and postoperative opioid requirements. Moreover, blood loss during and after the procedure is diminished. Epidural anesthetic distribution should be anticipated in a minority of cases.

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