Ambulatory Continuous Posterior Lumbar Plexus Nerve Blocks after Hip Arthroplasty

Ilfeld, Brian M.; Ball, Scott T.; Gearen, Peter F.; Le, Linda T.; Mariano, Edward R.; Vandenborne, Krista; Duncan, Pamela W.; Sessler, Daniel I.; Enneking, F. Kayser; Shuster, Jonathan J.; Theriaque, Douglas W.; Meyer, R. Scott

doi:10.1097/aln.0b013e318182a4a3

Cited by 102 publications

(84 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Early ambulation after TKA has been shown to help decrease deep venous thrombosis of the legs, enhance muscle strength and gait control, and decrease hospital LOS [21,30]. Although the analgesic benefits of CPNB in the setting of joint arthroplasty have been shown previously, clinical studies demonstrate that perineural local anesthetic infusions exert varying degrees of analgesia and motor block at different anatomic sites [11,12,14,15,17]. Recent studies of femoral nerve and lumbar plexus catheters have shown that typical perineural local anesthetic infusion doses produce clinically significant quadriceps weakness when administered via catheters inserted using conventional techniques [3,6,16].…”

Section: Discussionmentioning

confidence: 99%

Continuous Adductor Canal Blocks Are Superior to Continuous Femoral Nerve Blocks in Promoting Early Ambulation After TKA

Mudumbai

Kim

Howard

et al. 2014

Clinical Orthopaedics &Amp; Related Research

121

View full text Add to dashboard Cite

Background Femoral continuous peripheral nerve blocks (CPNBs) provide effective analgesia after TKA but have been associated with quadriceps weakness and delayed ambulation. A promising alternative is adductor canal CPNB that delivers a primarily sensory blockade; however, the differential effects of these two techniques on functional outcomes after TKA are not well established. Questions/purposes We determined whether, after TKA, patients with adductor canal CPNB versus patients with femoral CPNB demonstrated (1) greater total ambulation distance on Postoperative Day (POD) 1 and 2 and (2) decreased daily opioid consumption, pain scores, and hospital length of stay.Methods Between October 2011 and October 2012, 180 patients underwent primary TKA at our practice site, of whom 93% (n = 168) had CPNBs. In this sequential series, the first 102 patients had femoral CPNBs, and the next 66 had adductor canal CPNBs. The change resulted from a modification to our clinical pathway, which involved only a change to the block. An evaluator not involved in the patients' care reviewed their medical records to record the parameters noted above. Results Ambulation distances were higher in the adductor canal group than in the femoral group on POD 1 (median [10 Conclusions Adductor canal CPNB may promote greater early postoperative ambulation compared to femoral CPNB after TKA without a reduction in analgesia. Future randomized studies are needed to validate our major findings. Level of Evidence Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

show abstract

Section: Discussionmentioning

confidence: 99%

Continuous Adductor Canal Blocks Are Superior to Continuous Femoral Nerve Blocks in Promoting Early Ambulation After TKA

Mudumbai

Kim

Howard

et al. 2014

Clinical Orthopaedics &Amp; Related Research

121

View full text Add to dashboard Cite

show abstract

“…Wegener and colleagues 24 Ilfeld and colleagues 21 Ilfeld and colleagues 22 Ilfeld and colleagues 20 Ilfeld and colleagues 3 Ilfeld and colleagues 5 Williams and colleagues postoperative day 2 linked the falls to a violation of postoperative safety instruction and ambulation without supervision. 24 After repeated patient and nursing education about peripheral nerve block-induced muscle weakness and the risk of falling, no subsequent falls occurred within the study period.…”

Section: Discussionmentioning

confidence: 99%

Falls and major orthopaedic surgery with peripheral nerve blockade: a systematic review and meta-analysis

Johnson

Kopp

Hebl

et al. 2013

British Journal of Anaesthesia

142

View full text Add to dashboard Cite

Editor's key points † The authors aimed to review an important issue of the risk of postoperative falls after peripheral nerve block. † Only five studies qualified for meta-analysis; the patients had received lumbar plexus block or not. † Continuous lumbar plexus block increased the risk of falls compared with non-continuous block or no block. † The review, albeit involving a small number of studies, raises an important issue worthy of further research.Summary. 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. Major lower extremity joint arthroplasties are common orthopaedic procedures requiring aggressive postoperative pain management to achieve successful functional outcomes such as participation in early physical therapy. 1 2 Peripheral nerve blockade has been shown to decrease hospital length of stay and provide superior pain control with fewer side-effects compared with epidural regional anaesthesia or patientcontrolled i.v. opioid therapy. 3 However, there is controversy as to whether the benefits of peripheral nerve blockade come at the price of increasing the risk for postoperative falls. -11Falls in hospitalized patients are the focus of increasing attention. Postoperative falls can occur in as many as 1.6% of hospitalized surgical patients. 12 In 2008, the Centers forMedicare and Medicaid services included falls in the list of hospital-acquired conditions. Thus, if a fall occurs during an admission that hospital may not receive additional reimbursement for fall-associated costs. 13Falls may occur after orthopaedic surgery regardless of the presence of peripheral nerve blockade. Yet, prolonged quadriceps weakness resulting from lumbar plexus blockade may contribute to an increased fall risk. 6 The role of peripheral nerve blockade on postoperative fall risk has not been systematically studied. Furthermore, this specific clinical question has never been rigorously reviewed after a premeditated, transparent scientific methodology that allows the most valid analysis of the available literature. The aim of this systematic review with meta-analysis will be to advance our knowledge of falls occurring among patients who have undergone major orthopaedic lower extremity surgery with and without the presence of peripheral nerve blockade through quantitative and qualitative analysis of all available evidence. MethodsA protocol-driven systematic review addressing the intervention peripheral ...

show abstract

“…Some data suggest that a 4-d continuous lumbar plexus block may be compatible with successful postoperative ambulation. Recent studies did not have enough power though, to show statistical significant superiority compared to overnight use [21] . Further, it has to be noted that under peripheral nerve block, for example a continuous lumbar plexus block, the risk of postoperative falls seems to be increased compared to non-continuous or no block used in patients with major lower extremity orthopedic surgery.…”

Section: Benefits and Pitfallsmentioning

confidence: 99%

Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review

Opperer

Danninger

Stundner

et al. 2014

WJO

View full text Add to dashboard Cite

Over the last decades the demand for hip surgery, be it elective or in a traumatic setting, has greatly increased and is projected to expand even further. Concurrent with demographic changes the affected population is burdened by an increase in average comorbidity and serious complications. It has been suggested that the choice of anesthesia not only affects the surgery setting but also the perioperative outcome as a whole. Therefore different approaches and anesthetic techniques have been developed to offer individual anesthetic and analgesic care to hip surgery patients. Recent studies on comparative effectiveness utilizing population based data have given us a novel insight on anesthetic practice and outcome, showing favorable results in the usage of regional vs general anesthesia. In this review we aim to give an overview of anesthetic techniques in use for hip surgery and their impact on perioperative outcome. While there still remains a scarcity of data investigating perioperative outcomes and anesthesia, most studies concur on a positive outcome in overall mortality, thromboembolic events, blood loss and transfusion requirements when comparing regional to general anesthesia. Much of the currently available evidence suggests that a comprehensive medical approach with emphasis on regional anesthesia can prove beneficial to patients and the health care system.

show abstract

Ambulatory Continuous Posterior Lumbar Plexus Nerve Blocks after Hip Arthroplasty

Abstract: Background-The authors tested the hypotheses that after hip arthroplasty, ambulation distance is increased and the time required to reach three specific readiness-for-discharge criteria is shorter with a 4-day ambulatory continuous lumbar plexus block (cLPB) than with an overnight cLPB.

Cited by 102 publications

References 34 publications

Continuous Adductor Canal Blocks Are Superior to Continuous Femoral Nerve Blocks in Promoting Early Ambulation After TKA

Continuous Adductor Canal Blocks Are Superior to Continuous Femoral Nerve Blocks in Promoting Early Ambulation After TKA

Falls and major orthopaedic surgery with peripheral nerve blockade: a systematic review and meta-analysis

Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review

Contact Info

Product

Resources

About