Lumbar Plexus Nerve Block Research Articles

Efficacy of combined lumbar plexus and parasacral sciatic nerve block in elderly patients undergoing hip fracture surgery: a retrospective analysis

Aims: Hip fractures are a major cause of morbidity and mortality in the elderly population. Anesthesia management significantly affects outcomes in elderly patients. In recent years, peripheral nerve blocks acquired importance, especially in patients where subarachnoid blocks are contraindicated or in patients with severe pulmonary or cardiac diseases. This study aimed to retrospectively evaluate the efficacy of combined lumbar plexus block and parasacral sciatic nerve block in geriatric populations. Methods: Data from patients over 70 years of age (ASA III) who underwent surgery for hip fracture and received combined lumbar plexus and parasacral sciatic nerve blocks between 2014 and 2024 were retrospectively analyzed. The efficacy of anesthesia, the need for intraoperative rescue anesthesia, and hemodynamic parameters were evaluated. Results: The mean age of the 98 patients included in the study was 79.81 ± 8.94 years. Most patients had concomitant chronic diseases. A total of 19 (19.94%) patients were administered Fentanyl 50 mcg and Propofol 0.5 mg/kg for pain at the beginning of surgery, and none of the patients who received sedoanalgesia experienced severe respiratory distress or low oxygen saturation. Anesthesia and analgesia were effectively administered, and the need for intraoperative rescue anesthesia was low. Hemodynamic parameters remained stable. Conclusion: Combined lumbar plexus and parasacral sciatic nerve block is an effective anesthetic method for hip surgery in elderly patients with comorbidities. This method reduces the need for general anesthesia, provides comprehensive analgesia, and maintains hemodynamic stability.

USG Guided Lumbosacral Plexus Block for Surgery for Fracture Hip in High-Risk Patients– A Retrospective Case Series

Background 1.6 million patients worldwide are victims of hip fracture. The incidence is expected to rise with ageing of world’s population. Elderly patients with hip fracture pose a medical challenge for the anesthesiologist and are often associated with high incidence of morbidity and mortality. Early surgical fixation of fractured joint is necessary to reduce associated morbidity. Advanced age and delayed surgical correction and medical history are independent factors determining 1 year mortality after hip fixation which is 23.9% in these patients. Objective: In this case series where we share our experience of fracture femur fixation performed under USG guided combined lumbosacral block for 19 patients of ASA 3/4 physical status. Method: Hip fracture fixation was performed under USG guided and neurostimulation technique Lumbar plexus and Para-sacral sciatic nerve block with 20 ml and 15 ml of 0.3% Ropivacaine respectively. All patients were shifted to ICU for further care. Conclusion: USG guided Lumbosacral plexus block for surgeries around the hip joint can be used as a sole anesthetic in high-risk patients. Detailed preoperative evaluation and optimization, vigilant patient selection, counselling, monitoring, providing optimum drug dosage are key for success. Keywords: Lumbosacral plexus block, Hip fracture, USG-guided

Lumbar plexus block combined with general anesthesia in treating postoperative delirium of hip fracture in elderly patients

To explore lumbar plexus nerve block combined with general anesthesia in elderly patients undergoing hip operation could improve analgesia effect, reduce consumption of analgesics, prevent inflammatory reaction, and avoid postoperative delirium(POD). Totally 200 elderly patients underwent hip fracture surgery from February 2020 to September 2021 were selected and were divided into observation group and control group according to different anesthesia methods. There were 97 patients in observation group including 66 males and 33 females; aged (70.23±6.60) years old;body mass index (BMI) was (23.13±1.94) kg·m-2;19 patients with hemi arthroplasty, 46 patients with total hip arthroplasty, and 32 patients with femur intertrochanteric fixation;treated with lumbar plexus block combined with general anesthesia. There were 94 patients in control group, including 66 males and 33 females;aged (68.80±6.24) years old;BMI was (22.88±1.85) kg·m-2;14 patients with hemi arthroplasty, 39 patients with total hip arthroplasty, and 41 patients with femur intertrochanteric fixation;treated with only general anesthesia. Nine patients were separated due to the change of surgical protocol or chronic disease. The incidence of POD at 1, 2 and 3 days after surgery, mini-mental state examination (MMSE) score, visual analogue scale (VAS) in resting state, serum inflammatory factors levels [such as C-reactive protein(CRP), interleukin-1β(IL-1β), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α)] at 1 d before operation, 1 and 6 h after surgery, consumption of sufentanil between two groups were compared. The incidences of POD in observation group were lower than control group at 1, 2 and 3 days of operation (P<0.05), MMSE score in observation group was higher than that of control group (P<0.05), VAS in observation group was lower than that of control group (P<0.01). The incidences of POD decreased and MMSE score were increaed in both groups day by day (P<0.01). The levels of CRP, IL-1β, IL-6 and TNF-α in observation group were lower than that of control group at 1 h after operation (P<0.01). The levels of CRP, IL-6 and TNF-α in observation group were lower than that of control group at 6 h after operation (P<0.01), while no statisitical difference in IL-1β between two groups(P>0.05). The consumption of sufentanil in observation group was lower than that of control group (P<0.01). Compared with general anesthesia, lumbar plexus nerve block combined with general anesthesia for the operations of hip fracture in elderly patients has better analgesic effect, has advantages of slight inflammatory reaction, and could decrease consumption of opioid and incidence of POD.

A Case Report: Combined Sciatic Nerve and Lumbar Plexus Nerve Block in A Patient with Acute Decompensated Heart Failure Undergoing Lower Extremity Surgical Debridement

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Peripheral nerve block for lower extremity surgeries requires a minimum of two block injections. Although the combination of the lumbar plexus block and the sciatica block is a procedure that requires large doses of local anesthetic, which may induce cardiotoxicity, a recent study suggests that change in the hemodynamic system is not clinically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case Description:&lt;/strong&gt; We report a case of a 53-year-old male presenting with a worsened shortness of breath two days before hospital admission. He also experienced a sudden high fever and pain on his right thigh. The patient had a history of Heart Failure (EF 28%) and Congestive liver disease and was diagnosed with right femur cellulitis with right phlegmon. Surgical debridement was planned to treat sepsis. Right lumbar plexus block and right sciatica block were performed as surgical anesthesia. The surgery duration was one hour, and the patient was transferred to the PACU. The patient was treated in ICU before being admitted to the general ward and was discharged on day three post-surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The combination of Sciatic nerve and lumbar plexus nerve block is an effective anesthesia and analgesia technique for lower limb surgery in individuals with a severe heart condition. &lt;/p&gt;

Combined lumbar plexus sciatic nerve block for hip fracture: a case series with 442 patients

Introduction: Hip fractures are a global health problem in the elderly population. The mortality and morbidity after anesthesia are high in the elderly population with hip fractures due to numerous comorbidities. In recent years, the combined lumbar sciatic block (CLSB) method is safely applied in high-risk hip fracture surgeries. This study aims to examine 442 cases of hip fracture surgery in our clinic. Method: 442 high-risk patients operated in Istanbul University Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Orthopedics and Traumatology between 2004 and 2016 are included in this retrospective study. Neurostimulation technique combined with lumbar plexus and sciatic nerve block applied in all cases. The Lumber plexus block consists of bupivacaine 15 cc 0.5 % and prilocaine 15 cc 2%. Sciatic nerve block consists of bupivacaine 10 cc 0.5 % and prilocaine 10 cc 2%. Cases are evaluated for anesthesia quality and complication rate. Results: There was no need for any sedation or analgesia in 199 cases. Sedation was required in 147 cases. In 82 cases, the need for sedation combined with analgesia occurred. The conversion to general anesthesia was required in 14 cases. Complication wise, the epidural spread was observed in 5 cases and 3 cases got convulsions. Conclusion: It is concluded that CLSB is a safe alternative technique to use in high-risk hip fracture surgery.

Effects of posterior lumbar plexus block on anesthesia and sedation in postmenopausal patients with osteoporotic subtrochanteric comminuted fractures

ABSTRACT To study the effect of posterior lumbar plexus nerve block on anaesthesia and sedation in postmenopausal patients with osteoporotic subtrochanteric femoral comminuted fractures. The research subjects selected 48 patients with postmenopausal osteoporotic subtrochanteric comminuted fractures who were hospitalized between January 2020 and January 2022, and were allocated to clusters according to the random number TBL approach. The controlling cluster (24 situations) underwent dura mater Under external anesthesia, the test cluster (24 situations) underwent posterior lumbar plexus block, and the block effect, anesthesia effect, sedation effect, hemodynamics, vital signs and reactions of adverse nature were contrasted involving the two clusters. In comparison to the control group, the test group had a longer duration of anesthesia and motor block, higher oxygenation indices but lower ITBVI, GEDVI, and ScrO2 values, lower MAP levels, and lower BIS contraction values at 5, 15, and 30 minutes following anesthesia (P < 0.05). The test group had shorter induction time and block onset time compared to the control group (P < 0.05), and a lower incidence of adverse reactions (16.67% vs. 29.17% in the control group), but the variation was not noTBL (P < 0.05). Posterior lumbar plexus nerve block in postmenopausal patients with osteoporotic subtrochanteric femoral comminuted fractures has a better sedative effect, shortens the induction time of anaesthesia and the onset of block, promotes sTBL haemodynamic indexes and has fewer adverse effects to ensure safety.

Lumbar Plexus Nerve Blocks for Perioperative Pain Management in Cerebral Palsy Patients Undergoing Hip Reconstruction: More Effective Than General Anesthesia and Epidurals.

Hip reconstruction in patients with cerebral palsy (CP) is associated with. significant postoperative pain. However, adequate analgesia can be difficult to achieve. in this population due to spasticity, communication barriers, and postoperative. spasticity. Recently, multimodal pain management techniques such as epidurals and. regional nerve blocks have been described for postoperative pain control, but it is unclear if 1 technique is more beneficial. The purpose of this study was to compare the outcomes of different perioperative pain management techniques. This study is a retrospective review of a consecutive series of children with CP over a 5-year period at a single pediatric tertiary-care hospital who underwent hip reconstruction (proximal femoral osteotomy with or without a pelvic osteotomy). Patients were subdivided based on their anesthetic protocol into the following groups: general anesthesia alone (G), general anesthesia with an epidural (E), and general anesthesia with lumbar plexus block (LPB). Our primary outcome was cumulative postoperative narcotic consumption (converted to morphine equivalents). Secondary outcomes included length of stay (LOS), average postoperative heart rate, and pain scores. analysis of variance testing was utilized to compare differences between the groups. Fifty-four patients who underwent hip reconstruction were included: 19 in the G group, 18 in the E group, and 17 in the LPB group. LOS was significantly higher in the E group compared with the G and LPB groups: F(2,51)=3.58, P=0.04. The average pain score was significantly lower in the LPB group compared with the others: F(2,51)=4.26, P=0.02. The average postoperative heart rate was significantly lower in the LPB group: F(2,51)=7.08, P<0.01. Postoperative narcotic consumption was significantly lower in the LPB group: F(2,51)=11.57, P<0.01. The LPB patients required the least amount of narcotics compared with the other groups. This, combined with a lower perioperative heart rate and shorter LOS would suggest these patients experienced less pain over the time of their in-patient stay. In comparison to general anesthesia alone and epidural anesthesia, lumbar plexus nerve blocks are an effective pathway for postoperative pain control after hip reconstruction in a CP population. Level III-Case control or retrospective comparative study.

Review on Nerve Blocks Utilized for Perioperative Total Knee Arthroplasty Analgesia.

Total Knee Arthroplasty (TKA) is an increasingly common procedure performed for advanced osteoarthritis. Optimal perioperative pain management strategies are critical for early mobilization and shorter hospital stays in TKA. Peripheral nerve blocks commonly used in TKA perioperative analgesia including individual and combined femoral, obturator, sciatic, lumbar plexus, and adductor canal nerve blocks. Overall, the safety profile varies depending on which block is utilized, but the current evidence suggests when optimally chosen and delivered, peripheral nerve blocks may provide a safe, effective option for perioperative analgesia. Determining optimal analgesic regimens for total knee arthroplasty is critical to improve postoperative pain, patient satisfaction, decreasing opioid usage, recovery times and functional outcomes, and as such, peripheral nerve blocks may represent a viable option to supplement analgesic requirements in the perioperative period.

Posterior Lumbar Plexus Block Anesthesia for Elderly Patients with Lower Limb Fracture.

The incidence rate of lower limb fractures is high and has increased over the recent years, which affects the physical and mental health and the daily activities of patients. Lower limb fractures are often treated surgically. Therefore, an effective anesthesia regimen is crucial for a smooth and stable operation. To investigate the efficacy of posterior lumbar plexus block anesthesia during surgery for elderly patients with lower extremity fractures. In total, patients were divided into study and control groups. Anesthesia was administered by posterior lumbar plexus nerve block in the study group and epidural anesthesia in the control group. Hemodynamic parameters, anesthesia condition, pain level (VAS), and adverse effects were measured in both groups before anesthesia (T0), at anesthesia induction (T1), 30 min into the operation (T2), and at the end of the operation (T3). At T0, there were no significant differences in MAP and HR between the study and control groups. However, MAP and HR in the study group were significantly lower than those in the control group at T1, T2, and T3. The BIS value of the study group at each time point after anesthesia was significantly lower than that of the control group. The onset and induction time of anesthesia in the study group were also significantly shorter than those in the control group. Preoperative VAS scores did not differ between the study and control groups. However, the VAS scores of the study group at each time point were significantly lower than those of the control group. There was no significant difference in the incidence of adverse reactions between the two groups. Our results suggest that anesthesia with posterior lumbar plexus block surgery for lower extremity fractures in elderly patients can maintain hemodynamic stability and reduce block onset time, anesthesia induction time, and pain.

Impact of combined nerve blocks on the outcome of hip replacement in elderly patients with acute cerebral infarction

Objective: To investigate the impact of ultrasound-guided lumbar plexus, sciatic nerve and L1 paravertebral combined nerve blocks on the outcomes of elderly acute cerebral infarction patients with femoral neck fracture who underwent hip replacement. Methods: The clinical data of 114 elderly acute cerebral infarction patients with femoral neck fracture and underwent artificial hip replacement surgery from May 2013 to September 2018 in Renmin Hospital of Wuhan University were retrospectively analyzed. The patients were divided into two groups based on the different anesthetic methods they received: general anesthesia (G group, n=48), lumbar plexus, sciatic nerve and L1 paravertebral combined nerve blocks (N group, n=66). The operation time, anesthesia time, blood loss, urine volume, norepinephrine dose, length of intensive care unit (ICU) stay, hospital mortality and postoperative 6-month mortality were observed and compared between the two groups. The mini-mental state examination (MMSE) scores and the national institute of health stroke scale (NIHSS) scores were evaluated, respectively. Meanwhile, plasma D-Dimer and S100β levels were measured 1 d before surgery, 3 d and 7 d after surgery. Results: There were no significant differences in the baseline characteristics, operation time, anesthesia time, blood loss and length of ICU stay between the two groups (all P>0.05). Compared with group G, the dosage of norepinephrine [(86±23) μg vs (184±28) μg], hospital mortality [7.6% (5/66) vs 25.0% (12/48)] and postoperative 6-month mortality [12.1% (8/66) vs 31.3% (15/48)] were significantly decreased in group N, while the urine volume [(265±58) ml vs (160±55) ml] was significantly increased (all P<0.01). The MMSE scores (9.9±3.0 vs 14.6±2.4) in group N were significantly higher than those in the group G 3 d after surgery, while the NIHSS scores (15.3±3.2 vs 9.9±3.5), plasma D-Dimer [(10.8±2.5) mg/L vs (7.3±2.2) mg/L] and S100β levels [(326±35) ng/L vs (276±29) ng/L] were significantly lower than those in group G (all P<0.01). Conclusion: Combined nerve blocks can reduce the mortality of acute cerebral infarction patients undergoing hip replacement surgery, and improve the brain function and prognosis of the patients.

Nerve Stimulator Guided Lumbar Plexus and Parasacral Sciatic Nerve Block for above Knee Amputation in a High-Risk Patient: A Case Report

Ultrasound guidance is the most widely used nerve localization method of choice for peripheral nerve blocks. It can provide direct visualization of the needle, nerves, and the spread of the local anesthetic improving the success rate. In contrast, nerve stimulation relies on surface landmark identification, and physiological responses of neural structures to electrical stimulation which can be highly influenced by injectates and physiologic solutions affecting its efficacy.

Observation of Postoperative Analgesia in Elderly Patients with PFNA By Routine Pulsed Lumbar Plexus Administration

Objective to observe the postoperative analgesia of elderly patients with PFNA by pulsed lumbar plexus administration. Methods: 90 patients with PFNA postoperative analgesia were selected and divided into three groups on average. The first group, 30 routine PCIA. The second group received PCEA analgesia after spinal anesthesia. In the third group, the intraoperative lumbar plexus nerve block was completed and the anesthetic catheter was indwelling. The drug administration mode was programmed pulse administration without background dose. The pain index, movement tissue index and the incidence of various adverse reactions were observed after PFNA. Results the pain score of peripheral nerve block program pulse group was significantly lower than that of general anesthesia group, the incidence of motor tissue was lower than that of epidural group, and the incidence of side effects was lower than that of general anesthesia group and epidural group. Conclusion patients with PFNA is mostly elderly patients with varying degrees of system disease and organ function degradation, extra week nerve block program pulse to VAS score is lower and less motor block, fewer side effects, is PFNA more effective postoperative analgesia mode, you can reply as soon as possible to the patient's activity ability, improve the prognosis of patients.

The clinical application of ultra-sound guided anterior lumbar plexus combined with buttock epithelial nerve block on elderly patients undergoing hip replacement surgery

Objective To observe the clinical application of ultra-sound guided anterior lumbar plexus combined with buttock epithelial nerve block on elderly patients undergoing hip replacement surgery. Methods Sixty elderly patients (range from 60 to 80 years old) scheduled for unilateral hip replacement surgery were randomly divided to anterior lumbar plexus combined with buttock epithelial nerve block group (group A) and anterior lumbar plexus nerve block group (group B) by random number table method. The airways of all the patients were controlled by laryngeal mask airway (LMA) in both groups. The bispectral index (BIS) of patients in both groups was maintained in the range of 45-55. The heart rate, systolic and diastolic blood pressure when cutting were recorded respectively. The dosage of sulfentanyl, Visual Analogue Scale (VAS) score at 1, 6, 12 h and 24 h after surgery were recorded. The period from end of surgery to extubation, first off-bed activity after surgery were evaluated. Results The heart rate and blood pressure of patients in group A were less than those indexes of patients in group B at T1, T2, T3 (P<0.05). The averaged dosage using of sulfentanyl of group A was less than the dosage of group B (P<0.05). The periods from end of surgery to extubation and off-bed activity of group A were shorter than the periods in group B (P<0.05). The VAS scores at 1, 6, 12 h after surgery in group A were lower than those scores in group B (P<0.05). Conclusions Compared with anterior lumbar plexus nerve block, ultra-sound guided anterior lumbar plexus combined with buttock epithelial nerve block could help maintain circulation stability, reduce usage of opioids during operation, shorten the period of off-bed activity and the period from end of surgery to extubation and offer better analgesia effect on elderly patients undergoing hip replacement surgery. Key words: Buttock epithelial nerve block; Ultra-sound guidance; Anterior lumbar plexus nerve block; Rip replacement surgery; Aged

Dexmedetomidine as an adjuvant to bupivacaine on combined posterior lumbar plexus and sciatic nerve blocks, is it effective?

ABSTRACTBackground: Many drugs were added bupivacaine to extend the total time of analgesia in the postoperative period. Dexmedetomidine was a successful additive in neuraxial block. It provides stable hemodynamics and better and prolonged analgesia after surgery. By this present work, we aim to assess the role of added dexmedetomidine to bupivacaine during combined sciatic and posterior lumbar plexus blocks during femur surgery regarding period of sensory and motor blocks, efficacy of its analgesic effect and incidence of adverse effects.Methods: Our trial was done on 80 patients undergoing femur surgeries. They were all randomly chosen into two groups which have undergone combined sciatic nerve and posterior lumbar plexus blocks as solo anesthetic technique by peripheral nerve blocks. Group I: patients received bupivacaine 0.5% with no additives. Group II: patients received dexmedetomidine 100 µg with bupivacaine 0.5%.Results: Adding dexmedetomidine prolongs total duration of motor and sensory block significantly by more than twofold (p = 0.001) as well as it took shorter time to achieve loss of pinprick sensation and also a shorter time was required to reach modified Bromage scale grade IV. Patients in Group 1 requested analgesia earlier after surgery, as well as they had significantly higher morphine consumption postoperatively compared to those in Group II (p = 0.001).Conclusion: Adding of dexmedetomidine to the local anesthetic lessen the time till the beginning of the block and lengthen its total duration. It also prolongs analgesia postoperatively and has few side effects.

Application of lower limb nerve block combined with slow induction of light general anesthesia and tracheal induction in elderly hip surgery.

Background:This study aims to evaluate the effectiveness and safety of lower limb nerve block combined with slow induction of light general anesthesia and tracheal intubation in hip surgery in the elderly.Methods:Thirty elderly patients who underwent hip surgery under the lower limb nerve block were randomly divided into 2 groups: slow induction of light general anesthesia and tracheal intubation group (group M), and laryngeal mask light general anesthesia group (group H). After undergoing total intravenous anesthesia without muscle relaxants, all patients received sciatic nerve, lumbar plexus, and paravertebral nerve blocks. The hemodynamic situations, dosage of anesthetics, time for awakening and extubation (or laryngeal mask removal), and incidence of respiratory adverse reactions in the induction period were recorded.Results:Compared with baseline levels, the difference in mean arterial pressure (MAP) value at each time point after intubation/laryngeal mask removal in both groups was not statistically significant (P > .05). Furthermore, the time for awakening and extubation/laryngeal mask removal, and anesthetic dosage were significantly decreased in group M, when compared with group H (P < .05). For the incidence of adverse reactions, the incidence of poor sealing and hypoxia was significantly lower in group M than in group H (P < .05), and the incidence of sore throat was significantly lower in group H than in group M (P < .05).Conclusion:Lower limb nerve block combined with slow induction of light general anesthesia and tracheal intubation was associated with smaller anesthetic dosage, and shorter duration of anesthesia induction and extubation/laryngeal mask after surgery.

Combined Sciatic and Lumbar Plexus Nerve Blocks for the Analgesic Management of Hip Arthroscopy Procedures: A Retrospective Review

ABSTRACTHip arthroscopy is a minimally invasive alternative to open hip surgery. Despite its minimally invasive nature, there can still be significant reported pain following these procedures. The impact of combined sciatic and lumbar plexus nerve blocks on postoperative pain scores and opioid consumption in patients undergoing hip arthroscopy was investigated. A retrospective analysis of 176 patients revealed that compared with patients with no preoperative peripheral nerve block, significant reductions in pain scores to 24 hours were reported and decreased opioid consumption during the post anesthesia care unit (PACU) stay was recorded; no significant differences in opioid consumption out to 24 hours were discovered. A subgroup analysis comparing two approaches to the sciatic nerve block in patients receiving the additional lumbar plexus nerve block failed to reveal a significant difference for this patient population. We conclude that peripheral nerve blockade can be a useful analgesic modality for patients undergoing hip arthroscopy.

Effect of dexmedetomidine given by different routes on combined lumbar plexus and sciatic nerve block with ropivacaine

Objective To evaluate the effect of dexmedetomidine (Dex) given by different routes on combined lumbar plexus and sciatic nerve block(CLPSNB) with 0.375% ropivacaine. Methods Ninety patients were randomly allocated into three groups (n=30): 0.375% ropivacaine 50 ml for CLPSNB in group R, 1 μg/kg Dex infused over 10 min+0.375% ropivacaine 50 ml for CLPSNB in group D+R, and 1 μg/kg Dex diluted in 0.375% ropivacaine 50 ml for CLPSNB in group DR. Groups R and DR were intravenously infused with the same volume of saline in group D+R. The onest time and duration of sensory and motor block, satisfaction of doctors, and side effects were recorded. Results Sensory and motor block onset time has no significant difference among three groups(P>0.05). Motor block duration and first time use of analgesics were longer in group DR[(768±246) min and (1 080±300) min] and group D+R[(732±204) min and (1 050±288) min] than group R[(420±126) min and (840±306) min](P 0.05). Conclusions Dex diluted in 0.375% ropivacaine for CLPSNB can provide good analgesic efficacy and satisfaction of doctors. Key words: Dexmedetomidine; Ropivacaine; Nerve block; Lumbar plexus; Sciatic nerve

Comparison of Lumbar Epidurals and Lumbar Plexus Nerve Blocks for Analgesia Following Primary Total Hip Arthroplasty: A Retrospective Analysis

BackgroundTotal hip arthroplasty (THA) is associated with significant postoperative pain. Both lumbar epidurals and lumbar plexus nerve blocks have been described for postoperative pain control, but it is unclear if one technique is more beneficial. MethodsUsing electronic medical records, a randomly selected, cohort of 58 patients with lumbar epidurals were compared with 58 patients with lumbar plexus nerve blocks following primary THA. The primary end point was 48-hour postoperative opiate consumption. Secondary end points included time of first ambulation, distance ambulated, level of assistance with ambulation, presence of side effects, and time to discharge. Descriptive statistics were calculated to characterize subjects in the different block-type groups. Comparisons in morphine consumption were conducted using linear mixed models. Primary and secondary end points were examined in multivariable models. ResultsPatients with lumbar plexus blocks consumed less opiates at 24, 36, and 48 hours relative to patients that received lumbar epidural catheters (P = .047, .002, and .002, respectively). Patients with lumbar plexus blocks ambulated earlier (24.6 ± 2.01 hours vs 31.7 ± 3.01 hours) and farther relative to patients with epidurals (P < .001 for both) and had discharge orders written earlier (58.2 ± 6.68 hours vs 73.6 ± 6.35 hours). ConclusionIn comparison to lumbar epidural catheters, lumbar plexus nerve blocks are an effective pathway for postoperative pain control following primary THA. Furthermore, this clinical pathway expedites physical rehabilitation and is more compatible with postoperative prophylactic anticoagulants.

Pre-operative Lumbar Plexus Block Provides Superior Post-operative Analgesia when Compared with Fascia Iliaca Block or General Anesthesia Alone in Hip Arthroscopy

Objectives:Nerve block administration in concert with general anesthesia can help manage post-operative pain and provide favorable muscle relaxation of the operative leg in hip surgery. However, the optimal nerve blockade_if any_for arthroscopic surgery of the hip remains undefined. Considerations specific to hip arthroscopy include control of intra-operative pain, adequate muscle relaxation to allow for distraction for work in the central compartment, and post-operative pain control. Dold et al. recently reported in AJSM that a pre-operative femoral nerve block administered in concert with general anesthesia led to decreased patient-reported pain scores at the 60 minute mark post-operatively. Given this demonstrated benefit of the pre-operative femoral nerve block, we hypothesized that a regional block that anesthetized the femoral nerve and the lateral femoral cutaneous nerve (as the fascia iliaca block does), or one that anesthetized the obturator nerve in addition to the femoral and lateral femoral cutaneous nerves (i.e. the lumbar plexus block), would provide additional benefit. The purpose of this study is to examine the effects of pre-operative fascia iliaca and lumbar plexus nerve blocks on post-operative pain and secondary post-operative variables following arthroscopic surgery of the hip.Methods:A retrospective chart analysis was conducted on 145 patients undergoing arthroscopic surgery of the hip in 3 groups. Group 1 (n=55) received general anesthesia only, Group 2 (n=30) received general anesthesia and a fascia iliaca nerve block, and Group 3 (n=60) received general anesthesia and a lumbar plexus nerve block. Post-operative measures were recorded, examined and compared. The primary outcome measure was patient reported pain scores (0-10) at 0, 30, 60, 90 and 120 minutes in the post-anesthesia care unit (PACU). Secondary variables examined included time spent in the PACU, morphine equivalent administered, and presence of nausea requiring anti-emetic medication.Results:Mid-term analysis revealed no benefit to the fascia iliaca block; this regional anesthesia technique showed no significant effect on any of the measured post-operative variables when compared to general anesthesia alone. We therefore abandoned this block in favor of the lumbar plexus block. Patients receiving a lumbar plexus block exhibited significantly decreased pain at each time point when compared to the fascia iliaca group, and at all but one time point when compared to the general anesthesia group (P<0.05). There was no difference in the time spent in the PACU, nor in morphine equivalent administered between any of the groups.Conclusion:The results of the current study indicate that for arthroscopic surgery of the hip, a pre-operative lumbar plexus regional block performed in conjunction with general anesthesia provides significant and clinically meaningful decreases in post-operative pain reported in the PACU when compared with general anesthesia alone or general anesthesia with fascia iliaca block. This relative benefit we found in our lumbar plexus block patients is likely attributable to the more complete and proximal nervous blockade afforded by the lumbar plexus block. Pre-operative fascia iliaca block provides no benefit compared with general anesthesia alone. Consideration should be given to abandoning fascia iliaca regional nerve block for anesthesia for hip arthroscopy.

A comparative study of spinal bupivacaine and fentanyl versus combined lumbar plexus and sciatic nerve block in lower limb orthopedic procedures

Context: Spinal anesthesia is a time-tested method for orthopedic surgeries of the lower limb while peripheral nerve block is a comparatively newer method and still under controversy. Aims: The aim of this study was to compare efficacy of spinal bupivacaine and fentanyl with combined lumbar plexus and sciatic nerve block in lower limb orthopedic procedures. Settings and Design: A randomized single-blinded prospective study conducted at orthopedic operation theater and perioperative area. Subjects and Methods: Sixty patients were randomly allocated into two groups, Group A received spinal anesthesia with 12.5 mg bupivacaine and 25 μg fentanyl, Group B received lumbar plexus block with 30 ml (0.25%) bupivacaine and sciatic nerve block with 25 ml (0.25%) bupivacaine. In Group B, three patients were converted to general anesthesia due to failure of development of block. In postoperative period, visual analog scale (VAS) score was assessed, and pethidine was used as rescue analgesic. Statistical Analysis Used: IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY, USA). Results: Faster onset of sensory and motor block was found in Group A. In the intraoperative period, incidence of hypotension and bradycardia was found to be higher in Group A although statistically insignificant. In the postoperative period, the VAS score difference between the two groups was found to be significantly higher in Group B till 6 h postoperative. The total duration of analgesia was significantly higher in Group B (690.00 ± 108.344 min) than in Group A (264.67 ± 25.962 min). The total dose of analgesic required in first 24 h was significantly less in Group B (200.00 ± 57.17 mg) than in Group A (371.67 ± 28.416 mg). Conclusion: Combination of lumbar plexus and sciatic nerve block provided effective unilateral analgesia for a prolonged time into the postoperative period.