Continuous Lumbar Plexus Block Research Articles

Retracted: Continuous Lumbar Plexus Block under the Guidance of the "Shamrock Method" Ultrasound: Analgesic Effects and Hemodynamic Effects after Total Knee Arthroplasty in Elderly Patients.

[This retracts the article DOI: 10.1155/2021/3531236.].

Continuous Lumbar Plexus Block under the Guidance of the "Shamrock Method" Ultrasound: Analgesic Effects and Hemodynamic Effects after Total Knee Arthroplasty in Elderly Patients.

Objective To explore the effect of continuous lumbar plexus block guided by the “Shamrock method” on postoperative analgesia and hemodynamics in elderly patients after total knee arthroplasty (TKA). Methods From January 2020 to December 2020 in our hospital, 98 patients who underwent TKA were selected. Using the random number table method, the patients were divided into two groups: a continuous lumbar plexus block group (group L), with 49 patients, and a continuous femoral nerve block group (group F), with 49 patients. The onset time and maintenance time of motor and sensory nerve blocks in patients were recorded. A visual analogue scale (VAS) was applied to assess the pain severity at 6, 12, 24, and 48 h after the operation. The VAS score (FVAS) was applied to evaluate the pain severity of the patients during 24 and 48 h after the operation and knee joint functional exercise. The levels of hemodynamic indexes such as heart rate, mean arterial pressure, and oxyhemoglobin saturation and the levels of hemorheological indexes such as plasma viscosity, high and low whole blood shear viscosity, fibrinogen, and hematocrit were detected and compared between the two groups immediately after the operation and at 12 h and 48 h after the operation, respectively. The incidence of adverse reactions induced by anesthesia was counted. Results The onset time of motor and sensory nerve blocks in group L was lower than that in group F, and the maintenance time was higher than that in group F (P < 0.05). The VAS scores of 6, 12, 24, and 48 h after operation in group L were significantly lower than those in group F (P < 0.05). The FVAS scores of group L at 24 and 48 h after operation were significantly lower than those of group F (P < 0.05). The heart rates of the patients in the two groups were higher at 12 h and 48 h after operation than those immediately after operation (P < 0.05). The heart rates at 12 h and 48 h after operation in group L were lower than those in group F (P < 0.05). The plasma viscosity, high whole blood shear viscosity, and low whole blood shear viscosity in the group L at 12 h and 48 h after operation were lower than those in group F (P < 0.05). There was no significant difference in the incidence of local anesthetic poisoning, nausea, vomiting, urinary retention, pruritus, and other adverse reactions between the two groups (P > 0.05). Conclusion The “Shamrock method” ultrasound-guided continuous lumbar plexus block in elderly patients after TKA has good analgesic effect, stable hemodynamics, little influence on hemorheology, and good safety. It is of great value to enhance the surgical effect and promote postoperative rehabilitation.

Continuous Lumbar Plexus Block vs Continuous Lumbar Erector Spinae Plane Block for Postoperative Pain Control After Revision Total Hip Arthroplasty

BackgroundOptimal pain management is key to successful recovery in revision total hip arthroplasty. Lumbar plexus blocks (LPBs) have traditionally been used for postoperative pain management. Recently, the lumbar erector spinae plane block (LESPB) has emerged as a promising regional anesthesia technique and is relatively simple to perform. Our study aimed to evaluate whether continuous LESPB provided better analgesia and clinical outcomes than continuous LPB in revision hip arthroplasty. Material and methodsWe compared 25 LPBs with 25 LESPBs performed from October 2017 to November 2018 for revision hip arthroplasty. The primary outcome of this study was difference in opioid consumption between the groups at 24 hours postoperatively. Secondary outcomes include pain scores, hospital lengths of stay, pain adjunct consumption, and incidence of postoperative nausea and vomiting. ResultsThere was no significant difference in average opioid consumption between the LPB and LESPB groups during the first 24 hours postoperatively (73.8 ± 68.1 mg vs 85.1 ± 69.7 mg, respectively, P = .57). Similarly, there was no significant difference in average pain scores (3.3 ± 2.1 vs 3.7 ± 1.8, respectively, P = .42). ConclusionsThere was no significant difference in opioid consumption and pain scores in patients with continuous LESPB compared with those with continuous LPB. While our study did not show a difference in these outcomes, the LESPB is a straightforward regional block that avoids many of the risks of LPBs and may be as effective for pain control.

Comparison of 0.125% and 0.2% ropivacaine in continuous lumbar plexus block for postoperative analgesia after total hip arthroplasty

Background: Lower concentrations of ropivacaine in continuous lumbar plexus block (LPB) have not been studied adequately. Thus, we designed this prospective, randomized, comparative study to evaluate the two different concentrations of ropivacaine (0.125% and 0.2%) in continuous LPB for postoperative pain relief following total hip arthroplasty (THA). Materials and Methods: Fifty patients undergoing THA under standardized subarachnoid block have been randomly allocated to receive a continuous infusion of either 0.125% (Group 1) or 0.2% (Group 2) of ropivacaine in LPB done under the guidance of peripheral nerve stimulator. The primary outcome was consumption of tramadol during the first 24 h and the secondary outcomes were quality of sensory and motor blockade and consumption of ropivacaine. Results: The total amount of tramadol did not differ significantly (P = 0.442) between the two groups. Furthermore, the duration of sensory and motor blockade did not differ significantly between the two groups. However, the average consumption of ropivacaine was significantly lower in Group 1 when compared to Group 2 (238.80 mg vs. 380.64 mg, P = 0.0001). Conclusion: Administration of 0.125% of ropivacaine can be a better alternative as it would decrease the total amount of the local anesthetic in continuous LPB.

A Randomized Study Comparing the Efficacy of Ultrasound Guided Lumbar Plexus Block and Epidural Anesthesia for Postoperative Analgesia in Patients Undergoing Total Hip Replacement.

Patients undergoing total hip replacement (THR) experience severe postoperative pain. The advantage of pain relief by continuous epidural anesthesia (CEA) is offset by various adverse effects. Ultrasound guided (USG) continuous lumbar plexus block (LPB) has emerged as an alternative approach for postoperative analgesia in patients undergoing THR, especially where epidural is difficult or contraindicated. This randomized controlled trial compared USG-LPB with CEA for postoperative pain relief until 48 hours in patients undergoing THR, with 0.5% ropivacaine (15 mL) used as boluses for both CEA and LPB. The mean time to the first bolus was 380.60 ± 77.66 min in the LPB group whereas it was 307.40 ± 83.60 min in the epidural group (P = 0.002). Thus, patients in the LPB group took more than one hour longer than the epidural group to take their first bolus, which is clinically meaningful besides being statistically significant. The pain score on movement was also significantly lower, and patient satisfaction higher, in the LPB group. There were no significant intergroup differences about motor power, pain at rest, total ropivacaine consumption, and adverse effects. USG-LPB is an effective alternative to CEA combined with general anesthesia for postoperative analgesia after THR.

Postoperative Satisfaction in Patients Undergoing Fracture Neck Femur Fixation After Continuous Facia Iliaca Block (CFIB) Versus Continuous Lumbar Plexus Block (CLPB)

AbstractBackground: It is thought that both CFIB and CLPB can decrease the length of hospital stay, morbidity and help early ambulation in patients with fracture neck of femur.Aim of the Study: To compare the postoperative analgesic efficacy and opioid spare effect of continuous ultrasound-guided lumbar plexus block and fascia iliaca compartment block in patients undergoing surgery for fractured neck of femur.Material and Methods: 40 patients with fracture neck femur were randomized intone of 2 blocks, CFIB and CLPB.Results: CFIB was superior to CLPB in total consumed dose of morphine, sensory and motor block for 48 hours postoperatively (p=0.006), hemodynamic stability (p<0.001), incidence of side effects (p=0.04) and patient satisfaction (p=0.06).Conclusion: Single injection lumbar plexus block provides postoperative analgesia for up to 18 hours, with avoidance of troubles of continuous infusion, with lower VAS scores and good patient satisfaction. However, it is considered a difficult technique with higher rate of complications and failure. On the other hand, Continuous infusion fascia iliaca block gives better quality analgesia, for up to 48 hours, and high patient satisfaction.

Intraoperative Assessment of Ultrasound Guided Continuous Facia Iliaca Block (CFIB) Versus Continuous Lumbar Plexus Block (CLPB) in Patients Undergoing Fracture Neck Femur Fixation

AbstractBackground: In the elderly and high risk patients, it is logic to prefer local anaesthesia rather than general anaesthesia. The fascia iliaca compartment block is an easy, available method for peri-operative analgesia in patients with painful conditions affecting the thigh, the hip joint and/or the femur. Lumbar plexus block is another form of deep blocks which is used to provide anesthesia and/or analgesia for the entire distribution of the lumbar plexus.Aim of Study: Intraoperative assessment of CFIB versus CLPB.Material and Methods: 40 patients with fracture neck femur were randomized intone of 2 blocks, CFIB and CLPB.Results: CFIB was significantly superior to CLPB as regards shorter time for catheter insertion (CIT) (p<0.001), earlier maximum motor block (p<0.001) and earlier peak of sensory block (p=0.008), intraoperative hemodynamic stability (p<0.001) while CLPB group showed significantly rapid onset of motor and sensory block (p<0.001, p<0.001).Conclusion: Continuous infusion fascia iliaca block gives better quality analgesia. It is an easy procedure that could be done in the emergency room. It is faster, safer and more applicable technique than continuous lumbar plexus block.

Continuous lumbar plexus block reduces the incidence of early postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty

To observe the impacts of continuous lumbar plexus block (CLPB) on postoperative cognitive dysfunction (POCD) in elderly patients undergoing hip arthroplasty. Methods: Sixty elderly patients scheduled for hip arthroplasty with general anesthesia, were randomly allocated into a CLPB group and a PCIA group (n=30 each). In the CLPB group, lumbar plexus block was performed before trachea intubation, and CLPB was used for postoperative analgesia. In the PCIA group, intravenous analgesia was controlled in patients after operation. Visual Analogue Scale (VAS) at 12, 24, and 48 h after operation was recorded. Mini-Mental State Examination (MMSE) scale was used to evaluate the cognitive dysfunction at the 1st day before operation (D0) and at the 1st (D1), 3rd (D3), and 7th (D7) days after operation and the occurrence of POCD was recorded. S-100β concentrations were detected by ELISA at D1, D3, and D7. Postoperative adverse events were recorded. Results: VAS scores at 12, 24, and 48 h after operation in the CLPB group were significantly lower than those in the PCIA group (P<0.05). Compared with the PCIA group, the MMSE scores were significantly higher (P<0.05), and the incidence of POCD at D1 and D3 was obviously reduced in the CLPB group (P<0.05). S-100β concentration at D1 and D3 in the CLPB group was significantly lower than that in the PCIA group (P<0.05). Conclusion: Application of CLPB in elderly patients undergoing hip arthroplasty could obviously relieve their postoperative pain, inhibit the production of S-100β, and reduce the incidence of early postoperative cognitive dysfunction.

Bloqueio perioperatório do plexo lombar e isquemia cardíaca em pacientes com fratura de quadril: ensaio clínico randomizado

BackgroundPerioperative myocardial ischemia is common among patients undergoing hip fracture surgery. Our aim is to evaluate the efficacy of perioperative continuous lumbar plexus block in reducing the risk of cardiac ischemic events of elderly patients undergoing surgery for hip fractures, expressed as a reduction of ischemic events per subject. MethodsPatients older than 60 years, ASA II–III, with risk factors for or known coronary artery disease were enrolled in this randomized controlled study. Patients were randomized to conventional analgesia using opioid intravenous patient‐controlled analgesia or continuous lumbar plexus block analgesia, both started preoperatively and maintained until postoperative day three. Continuous electrocardiogram monitoring with ST segment analysis was recorded. Serial cardiac enzymes and pain scores were registered during the entire period. We measured the incidence of ischemic events per subject registered by a continuous ST‐segment Holter monitoring. ResultsThirty‐one patients (intravenous patient‐controlled analgesia 14, lumbar plexus 17) were enrolled. There were no major cardiac events during the observation period. The number of ischemic events recorded by subject during the observation period was 6 in the lumbar plexus group and 3 in the intravenous patient‐controlled analgesia group. This difference was not statistically significant (p=0.618). There were no statistically significant differences in the number of cases with increased perioperative troponin values (3 cases in the lumbar plexus group and 1 case in the intravenous patient‐controlled analgesia group) or in terms of pain scores. ConclusionsUsing continuous perineural analgesia, compared with conventional systemic analgesia, does not modify the incidence of perioperative cardiac ischemic events of elderly patients with hip fracture.

Perioperative lumbar plexus block and cardiac ischemia in patients with hip fracture: randomized clinical trial

BackgroundPerioperative myocardial ischemia is common among patients undergoing hip fracture surgery. Our aim is to evaluate the efficacy of perioperative continuous lumbar plexus block in reducing the risk of cardiac ischemic events of elderly patients undergoing surgery for hip fractures, expressed as a reduction of ischemic events per subject. MethodsPatients older than 60 years, ASA II–III, with risk factors for or known coronary artery disease were enrolled in this randomized controlled study. Patients were randomized to conventional analgesia using opioid intravenous patient-controlled analgesia or continuous lumbar plexus block analgesia, both started preoperatively and maintained until postoperative day three. Continuous electrocardiogram monitoring with ST segment analysis was recorded. Serial cardiac enzymes and pain scores were registered during the entire period. We measured the incidence of ischemic events per subject registered by a continuous ST-segment Holter monitoring. ResultsThirty-one patients (intravenous patient-controlled analgesia 14, lumbar plexus 17) were enrolled. There were no major cardiac events during the observation period. The number of ischemic events recorded by subject during the observation period was 6 in the lumbar plexus group and 3 in the intravenous patient-controlled analgesia group. This difference was not statistically significant (p=0.618). There were no statistically significant differences in the number of cases with increased perioperative troponin values (3 cases in the lumbar plexus group and 1 case in the intravenous patient-controlled analgesia group) or in terms of pain scores. ConclusionsUsing continuous perineural analgesia, compared with conventional systemic analgesia, does not modify the incidence of perioperative cardiac ischemic events of elderly patients with hip fracture.

Continuous Posterior Lumbar Plexus Nerve Block Versus Periarticular Injection with Ropivacaine or Liposomal Bupivacaine for Total Hip Arthroplasty: A Three-Arm Randomized Clinical Trial.

Debate surrounds the issue of whether peripheral nerve blockade or periarticular infiltration (PAI) should be employed within a contemporary, comprehensive multimodal analgesia pathway for total hip arthroplasty. We hypothesized that patients treated with a continuous posterior lumbar plexus block (PNB) would report less pain and consume less opioid medication than those treated with PAI. This investigator-initiated, independently funded, 3-arm randomized clinical trial (RCT) performed at a single high-volume institution compared postoperative analgesia interventions for elective, unilateral primary total hip arthroplasty: (1) PNB; (2) PAI with ropivacaine, ketorolac, and epinephrine (PAI-R); and (3) PAI with liposomal bupivacaine, ketorolac, and epinephrine (PAI-L) using computerized randomization. The primary outcome was maximum pain during the morning (06:00 to 12:00) of the first postoperative day (POD) on an ascending numeric rating scale (NRS) from 0 to 10. Pairwise treatment comparisons were performed using the rank-sum test, with a p value of <0.017 indicating significance (Bonferroni adjusted). A sample size of 150 provided 80% power to detect a difference of 2.0 NRS units. We included 159 patients (51, 54, and 54 patients in the PNB, PAI-R, and PAI-L groups, respectively). No significant differences were found with respect to the primary end point on the morning of the first POD (median, 3.0, 4.0, and 3.0, respectively; p > 0.033 for all). Opioid consumption was low and did not differ across groups at any intervals. Median maximum pain on POD 1 was 5.0, 5.5, and 4.0, respectively, and was lower for the PAI-L group than for the PAI-R group (p = 0.006). On POD 2, maximum pain (median, 3.5, 5.0, and 3.5, respectively) was lower for the PNB group (p = 0.014) and PAI-L group (p = 0.016) compared with the PAI-R group. The PAI-L group was not significantly different from the PNB group with respect to any outcomes: postoperative opioid use including rescue intravenous opioid medication, length of stay, and hospital adverse events, and 3-month follow-up data including any complication. In this RCT, we found a modest improvement with respect to analgesia in patients receiving PNB compared with those receiving PAI-R, but not compared with those who had PAI-L. Secondary analyses suggested that PNB or PAI-L provides superior postoperative analgesia compared with PAI-R. For primary total hip arthroplasty, a multimodal analgesic regimen including PNB or PAI-L provides opioid-limiting analgesia. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Comparison of the epidural block and posterior lumbar plexus block for intra- and postoperative analgesia in total hip arthroplasty

Objectives. Evaluation of management of intra- and postoperative analgesia in patients who benefited from total hip arthroplasty in the surgical treatment of coxarthrosis. The achievement of this goal could reside in the comparison of two distinct methods of anaesthesiology: epidural analgesia and continuous lumbar plexus block. Materials and methods. The current prospective study, conducted between January 2014 and January 2016, targets a total of 48 patients who underwent total hip replacement surgery. There was a split in two groups: 23 patients benefited from epidural analgesia and 25 patients were selected for lumbar plexus block, depending on the procedure chosen by the anaesthetist. Both groups received the same concentration of initial dose of 0.75% Ropivacaine, the first group initially receiving 3 ml (test dose), then another 6 ml, and the second initially 5 ml (test dose), then 15 ml. Through catheters were injected continuously 8 ml / h of 0.2% Ropivacaine for the first group and 10 ml / h of Ropivacaine 0.375%, these doses being adjusted to Pain Visits, performed twice a day. The purpose of these visits was to monitor both the evolution of implanted catheters and the completion of mandatory protocols (these protocols monitor sensitivity and motor activity of limbs, initiation of mobilization, opioid supplementation to ongoing therapy, and patients'satisfaction with therapy, at catheter removal). Results. Patients in the first group had the highest satisfaction rate of 30.4%, compared to patients in the second group, who scored 52% for the 15 (maximum) level of satisfaction. In the first group of patients, 52.2% did not require additional opioids for ongoing therapy (in postoperative units or in the department), while for patients in the second group the percentage was 60%. In terms of complications, the differences are notable and have an important statistical value: the first category of patients, 52.17% (n = 12), the second category, 12% (n = 3). Day zero (surgery day) is not marked by significant differences between the two categories of people in treatment, in terms of pain intensity. At rest, 78.2% of the first category patients and 84% of the second category patients had a NRS of less than or equal to 4, while in the state of mobilization, the percentages were 78.2% and 80% respectively. The initiation of mobilization is an important parameter, which also presents variations between the two groups of patients: 73.9% of them initiated the mobilization on the first postoperative day (group I) and 88% initiated the mobilization on the first postoperative day (group II). Conclusions. Both methods of regional anaesthesia determine optimal analgesia for patients operated by THA with an onset of ideal mobilization from the first postoperative day, but the continuous lumbar plexus block produces better mobility in the second postoperative day and has a lower complications rate.

Comparison of continuous lumbar plexus block with different concentrations of dexmedetomidine added to ropivacaine for postoperative analgesia in elderly patients undergoing hip replacement

Objective To compare the efficacy of continuous lumbar plexus block(LPB)with different concentrations of dexmedetomidine added to ropivacaine for postoperative analgesia in elderly patients undergoing hip replacement. Methods Sixty elderly patients of both sexes, aged 65-85 yr, weighing 50-71 kg, of American Society of Anesthesiologists physical status Ⅱor Ⅲ, scheduled for elective total hip replacement, were divided into 2 groups(n=30 each)using a random number table: 0.5 μg/ml dexmedetomidine+ 0.1% ropivacaine group(group D1)and 1.0 μg/ml dexmedetomidine+ 0.1% ropivacaine group(group D2). Lumbar-sacral plexus block combined with general anesthesia was used.At the end of operation, LPB pump was started and set up to deliver a 4 ml bolus dose with a 30 min lockout interval and background infusion at a rate of 8 ml/h.The analgesia solution contained 0.5 μg/ml dexmedetomidine and 0.1% ropivacaine in group D1 and 1.0 μg/ml dexmedetomidine and 0.1% ropivacaine in group D2.Postoperative analgesia lasted for 48 h, and the visual analogue scale score was maintained ≤3.Patient-controlled intravenous analgesia(PCIA)pump was connected when break-through pain happened.PCIA solution contained morphine 50 mg diluted to 50 ml in 0.9% sodium chloride.PCIA pump was set up to deliver a 1 ml bolus dose with a 5 min lockout interval and no background infusion.When the visual analogue scale score >3, the patient-controlled LPB pump was used first, and 15 min later if analgesia was still ineffective, PCIA pump was applied.The number of patients in whom analgesia was effective and occurrence of adverse reactions were recorded. Results Compared with group D1, the rate of effective analgesia was significantly increased, and the incidence of nausea, vomiting and pruritus was decreased in group D2(P<0.05). No bradycardia, hypotension, over-sedation, respiratory depression, urinary retention or local skin infection was found in the two groups. Conclusion Continuous LPB with 1.0 μg/ml dexmedetomidine added to 0.1% ropivacaine provides better efficacy for postoperative analgesia in elderly patients undergoing hip replacement. Key words: Dexmedetomidine; Amides; Arthroplasty, replacement, hip; Nerve block; Lumbosacral plexus

Analgesic efficacy and safety of four different anesthesia/postoperative analgesia protocols in patients following total hip arthroplasty

Background/Aim. Hip replacement surgery can initiate significant postoperative pain caused by bone alterations, implant, and soft tissue or nerve injuries. Postoperative analgesia using regional techniques has been shown to have numerous advantages over the intravenous use of morphine. However, numerous side effects and complications of postoperative continuous epidural analgesia have been reported recently. The aim of this prospective, randomized study was to investigate whether continuous lumbar plexus block can be a safe and efficacious alternative for postoperative analgesia in comparison with epidural analgesia and patient-controlled analgesia with morphine (PCA morphine) for hip arthroplasty. Methods. This prospective study included 60 patients, scheduled for total hip arthroplasty. Patients were randomized into 4 groups: the group central nerve block ? epidural (CNB), the group peripheral nerve block ? lumbar plexus block (PNB), the group spinal anesthesia-PCA morphine (SAM) and the group general anesthesia-PCA morphine (GAM). The quality of analgesia and side effects (hypotension, nausea, vomiting, urinary retention) were recorded in all groups at 4 h, 12 h, and 24 h after surgery. Pain scores were assessed using Visual Analogue Scale (VAS), both at rest and on moving. Results. Our findings demonstrated that the use of a continuous lumbar plexus block provides effective analgesia at rest and on moving, during 24 h after hip arthroplasty. Pain scores varied significantly among the groups 4 h postoperatively (F = 21.827; p &lt; 0.01), 12 h postoperatively (F = 41.925; p &lt; 0.01) and 24 h postoperatively (F = 33.768; p &lt; 0.01) with the highest scores ? 3 in the GAM group. Patients from the PNB group had satisfactory analgesia, comparable with patients from the CNB group. The incidence of nausea was significantly lower in the PNB group 12 h after the operation (?2 = 9.712; p &lt; 0.01). The incidence of urine retention was significantly different 12 h after the operation, with a presence only in the CNB group, with the incidence of 33.3% (?2 = 16.365; p &lt; 0.01). In all studied groups, the incidence of hypotension was not significantly different postoperatively. Conclusion. Administration of postoperative analgesia using continuous lumbar plexus block produces satisfactory analgesia with a low incidence of side effects when compared to epidural analgesia or parenteral opioids following hip arthroplasty.

Surgical stress response following hip arthroplasty regarding choice of anesthesia and postoperative analgesia

Background/Aim. Significant surgical stress response consisting of hormonal, metabolic and inflammatory changes can be initiated by the hip replacement surgery. Appropriate choice of anesthesia and postoperative analgesia should provide diminution of surgical stress response and may reduce number of perioperative complications. Surgical stress response after peripheral nerve blocks has not been studied extensively in patients who underwent hip replacement. The aim of the study was to investigate whether continuous lumbar plexus block can significantly reduce surgical stress response in comparison to other types of postoperative analgesia – continuous epidural analgesia and intravenous patient controlled analgesia (PCA) with morphine. Methods. Prospective study included 60 patients, scheduled for total hip arthroplasty. The patients were randomized into 4 groups: group CNB (central nerve block - epidural), group PNB (Peripheral nerve block - lumbar plexus block), SAM (Spinal anesthesia- PCA (anesthesia) morphine) and GAM (General anesthesia + PCA with Morphine). Serum levels of cortisol, thyroid hormones (T3, T4) and thyroid stimulating hormone (TSH), insulin, glucose and C-reactive protein (CRP) were measured in all groups – preoperatively, as well as 4 h, 12 h and 24 h after surgery. Results. The study showed that average serum cortisol levels were significantly lower 4 h after the operation in the groups where methods of regional anesthesia were performed intraoperatively (SAM, CNB, PNB); (F = 19.867; p < 0.01). Groups with postoperative continuous catheter analgesia (CNB, PNB) had significantly lower serum cortisol levels 12 h after the operation (F = 8.050; p < 0.01). The highest serum insulin levels were detected 4 h postoperatively in the CNB and PNB group, while the lowest were in the GAM group (F = 5.811; p < 0.05). Twelve hours after the operation, the lowest values of insulin were measured in the SAM group (F = 5.052; p < 0.05), while 24 h postoperatively, the lowest values were found in the SAM and GAM group (F = 6.394; p < 0.05). T3, T4 and TSH levels showed slight reduction in comparison to preoperative values without statistical significance. Blood glucose levels were significantly different among the groups 4 h after surgery with the highest values recorded in the GAM group and the lowest ones in the SAM group (F = 10.084; p < 0.01). On the other hand, 12 h after the operation significant rise in blood glucose levels was detected in the SAM group (F = 7.186; p < 0.01) Levels of CRP increased remarkably 12 h and 24 h after the surgery, but without significant difference among the groups. Conclusion. Administration of postoperative analgesia using continuous lumbar plexus block following hip arthroplasty reduces significantly stress response in comparison to postoperative PCA with morphine and has comparable effects on hormone release to epidural analgesia. Spinal anesthesia provides the best diminution of surgical stress response in the early postoperative period in comparison with other types of intraoperative analgesia.

Complications After Continuous Posterior Lumbar Plexus Blockade for Total Hip Arthroplasty: A Retrospective Cohort Study.

While benefits of regional anesthesia in total hip arthroplasty (THA) are well documented, data describing the incidence of complications related to the use of posterior lumbar plexus blockade for THA remain limited. Our primary aim was to evaluate the incidence of infectious, bleeding, and neurological complications related specifically to the use of continuous posterior lumbar plexus block for elective THA. We reviewed the electronic medical records of all adult patients who underwent elective THA with continuous posterior lumbar plexus blockade between December 1, 2004, and April 30, 2015, using the Mayo Clinic Total Joint Registry. All complications were verified via manual chart review by 2 reviewers. Patient demographics, type of surgery, and complications were analyzed. A total of 9649 patients who underwent 11,395 THA procedures met the inclusion criteria. There were 8686 (76.2%) primary and 2709 (23.8%) revision THAs. There were no block-related infections (0.00%; 95% confidence interval [CI], 0.00%-0.03%) and only 1 block-related hematoma (0.01%; 95% CI, 0.00%-0.05%) in a patient with multiple risk factors for bleeding. There were 60 (0.53%; 95% CI, 0.40%-0.68%) perioperative nerve injuries. Forty-three were in the sciatic distribution (71.67%; incidence, 0.38%). Although there were no documented overt iatrogenic nerve injuries, the posterior lumbar plexus blockade could not be excluded as the potential cause in 9 cases (incidence, 0.08%) based on clinical distribution or electromyographic findings. In our large, single-center cohort study, we report no catheter-related infections, whereas catheter-related hemorrhagic and neurological complications also appear to be rare.

Postoperative analgesia for hip arthroplasty: comparison of continuous lumbar plexus block and epidural analgesia

JUSTIFICATICA E OBJETIVOS: A dor pos-operatoria da artroplastia total do quadril tem intensidade moderada a intensa, exigindo a realizacao de tecnicas analgesicas eficazes. O objetivo deste estudo foi comparar o bloqueio do plexo lombar continuo com a analgesia peridural em pacientes submetidos a artroplastia de quadril. METODOS: Estudo retrospectivo, observacional e analitico dos pacientes submetidos a artroplastia de quadril durante dois anos, sob analgesia pos-operatoria por bloqueios do plexo lombar continuo e peridural. Os pacientes foram divididos de acordo com a tecnica analgesica escolhida pelo anestesiologista. O protocolo consiste em infusao continua de ropivacaina a 0,2% (5mL/h) via cateter de bloqueio do plexo lombar continuo ou em ropivacaina a 0,1% e fentanil 3µg/mL (5mL/h) via cateter peridural. Recorrendo aos registos da Unidade de Dor Aguda, foram comparados os tres dias pos-operatorios dos grupos bloqueio do plexo lombar continuo e peridural em relacao a intensidade da dor, analgesia de resgate, complicacoes e tempo de internacao hospitalar. RESULTADOS: Foram incluidos 162 pacientes. A maioria de ambos os grupos nao apresentou queixas de dor no primeiro dia pos-operatorio (77,6% bloqueio do plexo lombar continuo versus 79,2% peridural). Ambos os grupos nao diferiram em relacao a intensidade de dor nem a incidencia de necessidade de analgesia de resgate (23,5% bloqueio do plexo lombar continuo versus 22,1% peridural). O grupo bloqueio do plexo lombar continuo registrou menos complicacoes (4,7% versus 23,4%), nomeadamente bloqueio motor, nauseas, vomitos e prurido. A rara ocorrencia de complicacoes nao permite detectar diferencas significativas entre as tecnicas. A maioria dos pacientes de ambos os grupos obteve alta hospitalar no 3o dia pos-operatorio. CONCLUSAO: Em relacao a analgesia peridural, o bloqueio do plexo lombar continuo proporcionou analgesia semelhante com menos complicacoes.

Ambulatory Continuous Posterior Lumbar Plexus Blocks Following Hip Arthroscopy

Ambulatory Continuous Posterior Lumbar Plexus Blocks Following Hip Arthroscopy

Is L2 Paravertebral Block Comparable to Lumbar Plexus Block for Postoperative Analgesia After Total Hip Arthroplasty?

Continuous lumbar plexus block (LPB) is a well-accepted technique for regional analgesia after THA. However, many patients experience considerable quadriceps motor weakness with this technique, thus impairing their ability to achieve their physical therapy goals. We asked whether L2 paravertebral block (PVB) provides better postoperative analgesia (defined as decreased postoperative opioid consumption and lower pain scores), better preservation of motor function, and decreased length of hospital stay (LOS) compared to LPB in patients undergoing THA. Sixty patients undergoing minimally invasive THA under standardized spinal anesthesia were enrolled in this randomized controlled study. After exclusions, 53 patients were randomized into the L2 PVB (n = 27) and LPB (n = 26) groups. Patient-controlled analgesia was available for 24 hours. Motor and pain assessments were performed in the recovery room and at the end of 24 hours. LOS was also noted. Postoperative opioid consumption during the first 24 hours was less in the LPB group (mean ± SD: 24 ± 15 mg morphine) than in the L2 PVB group (32 ± 15 mg morphine; p = 0.005); however, postoperative pain scores were not different between groups. Postoperative motor and rehabilitation outcomes and LOS were also similar. Our study demonstrates that use of a LPB results in slightly less morphine consumption but comparable pain scores when compared with continuous L2 PVB. No difference was noted in terms of motor preservation or LOS. Although the difference in morphine consumption was only slightly in favor of the LPB group, the advantage of L2 PVBs noted by previous authors as preservation of motor function, was not seen. At our institute where LPBs have been performed for years, there seems to be no real advantage in switching to L2 PVBs. However, L2 PVB could be a reasonable alternative for operators who are wary of LPBs due to their high potential for complications and/or requiring advanced skills for its placement. But, since L2 PVBs are relatively new, not much is known about their complication profile. We recommend a thorough understanding of both techniques before attempting to place them. Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Falls and Major Orthopaedic Surgery With Peripheral Nerve Blockade

The objective of this systematic review with meta-analysis was to determine the risk for falls after major orthopaedic surgery with peripheral nerve blockade. Electronic databases from inception through January 2012 were searched. Eligible studies evaluated falls after peripheral nerve blockade in adult patients undergoing major lower extremity orthopaedic surgery. Independent reviewers working in duplicate extracted study characteristics, validity, and outcomes data. The Peto odds ratio (OR) with 95% confidence intervals (CIs) were estimated from each study that compared continuous lumbar plexus blockade with non-continuous blockade or no blockade using a fixed effects model. Ten studies (4014 patients) evaluated the number of falls as an outcome. Five studies did not contain comparison groups. The meta-analysis of five studies [four randomized controlled trials (RCTs) and one cohort] compared continuous lumbar plexus blockade (631 patients) with non-continuous blockade or no blockade (964 patients). Fourteen falls occurred in the continuous lumbar plexus block group when compared with five falls within the non-continuous block or no block group (attributable risk 1.7%; number needed to harm 59). Continuous lumbar plexus blockade was associated with a statistically significant increase in the risk for falls [Peto OR 3.85; 95% CI (1.52, 9.72); P=0.005; I2=0%]. Evidence was low (cohort) to high (RCTs) quality. Continuous lumbar plexus blockade in adult patients undergoing major lower extremity orthopaedic surgery increases the risk for postoperative falls compared with non-continuous blockade or no blockade. However, attributable risk was not outside the expected probability of postoperative falls after orthopaedic surgery.