Comparison of analgaesia with lumbar epidurals and lumbar plexus nerve blocks in patients receiving multimodal analgaesics following primary total hip arthroplasty: a retrospective analysis

Harvey, N. Robert; Wolf, Bethany J.; Bolin, Eric D.; Wilson, Sylvia H.

doi:10.1007/s00264-017-3465-7

Cited by 7 publications

(6 citation statements)

References 22 publications

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“…All opioids were converted to intravenous morphine milligram equivalents (MME) for comparison (1 mg morphine intravenous equal to fentanyl 10 µg intravenous, hydromorphone 0.15 mg intravenous, oxycodone 2 mg oral, and meperidine 7.5 mg intravenous) 3. A previous study found mean intravenous MME in patients undergoing THA with a LPB was 20.4±13.1 MME at 24 hours 2. A prior power calculation found a sample size of 92 subjects per group (184 total) would provide 80% power to detect non-inferiority using a one-sided two-sample t-test (significance level α=0.05) and assuming a mean of 20.4±13.1 MME in the LPB group, the margin of equivalence is 20% of the mean opioid consumption in the QL group, and a true difference between the means equals 0.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of lateral quadratus lumborum and lumbar plexus blocks for postoperative analgesia following total hip arthroplasty: a randomized clinical trial

Kelly

Wolla

Hay

et al. 2022

Reg Anesth Pain Med

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IntroductionEffective analgesia after total hip arthroplasty must minimize pain and optimize early ambulation. Lumbar plexus blocks (LPBs) provide analgesia but may cause motor weakness. Quadratus lumborum blocks (QLBs) may provide analgesia with preserved motor strength.MethodsThis trial randomized subjects scheduled for elective hip arthroplasty to receive an LPB or lateral QLB for postoperative analgesia. The primary outcome was opioid consumption at 12-hour postoperative. Non-inferiority of lateral QLBs compared with LPBs was conducted using a one-sided two-sample t-test. Secondary outcomes included pain scores, cumulative opioid consumption, quadriceps strength, time to ambulation, and distance ambulated. Differences in pain scores and opioid consumption over time between groups were evaluated using a linear mixed model.ResultsThe trial consented and randomized 111 subjects and 103 completed the study: LPB (n=50) and lateral QLB (n=53). Mean (95% CI) cumulative opioid consumption (mg) at 12-hour postoperative was not found to be non-inferior in the lateral QLB (15.9 (12.7 to 19.2)) vs the LPB (12.7 (10.2 to 15.1)) group (p=0.625). Pain scores in postoperative anesthetic care unit (PACU) and 24-hour postoperative did not differ. The maximum distance ambulated did not differ, but lateral QLB patients were 2.4 times more likely to ambulate in the first 12 hours (p=0.024) and had significantly greater quadriceps strength in PACU (p<0.001).DiscussionAlthough we were unable to demonstrate non-inferiority for opioid consumption at 12-hour postoperative, strength and mobilization were improved in lateral QLB subjects.Trial registration numberNCT04402437.

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Section: Methodsmentioning

confidence: 99%

“…Total hip arthroplasty (THA) improves quality of life and increased demand is projected over the coming years 1. While lumbar plexus blocks (LPBs) reduce postoperative pain and opioid consumption after THA,2 3 risks include the potential for quadriceps weakness, bleeding, and neuraxial local anesthetic spread.…”

Section: Introductionmentioning

confidence: 99%

Comparison of lateral quadratus lumborum and lumbar plexus blocks for postoperative analgesia following total hip arthroplasty: a randomized clinical trial

Kelly

Wolla

Hay

et al. 2022

Reg Anesth Pain Med

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“…If the operation time is too long, it is difficult to meet the requirements. In addition, postoperative headache may occur during spinal anesthesia, which is the most painful problem for patients after spinal anesthesia, making anesthesiologists and surgeons worried about spinal anesthesia [ 3 , 4 ]. Epidural anesthesia has the advantages of less interference to the respiratory and circulatory system, less physiological impact, faster postoperative recovery, less complications, etc.…”

Section: Introductionmentioning

confidence: 99%

Effects of Combined Spinal Epidural Anesthesia in Orthopaedic Surgery of Elderly Patients

Li¹,

Fan²,

Chen³

2022

Computational and Mathematical Methods in Medicine

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Objective. Combined spinal epidural anesthesia (CSEA) is applied to lower limb orthopaedic surgery in the elderly. This study is aimed at exploring the effect of CSEA in orthopaedic surgery of elderly patients. Methods. A total of 40 elderly patients with femoral fracture needing hip replacement or femoral head replacement in our hospital from June 2021 to June 2022 were selected as the research objects. The subjects were divided into observation group ( n = 20 ) and control group ( n = 20 ) by random number table method. The control group was given epidural anesthesia, while the observation group was given CSEA. Hemodynamic indexes (heart rate (HR) and mean arterial pressure (MAP)), visual analogue scale (VAS) pain score changes, anesthetic effects, and postoperative complications were compared between the two groups. Results. After operation, the observation group had lower HR and MAP values than the control group ( P < 0.05 ). The dosage of local anesthetics in the observation group was significantly less than that in the control group ( P < 0.05 ). The onset time and improvement time of sensory block in the observation group were significantly faster than those in the control group ( P < 0.05 ). The observation group had a lower VAS score than the control group ( P < 0.05 ). There was no significant difference in Bromage score or incidence of complications between the two groups ( P > 0.05 ). Conclusion. The use of CSEA has good anesthetic effect. It has the disadvantage of no headache after traditional spinal anesthesia, is not limited by time, and can be used for postoperative analgesia, which is more suitable for the anesthesia of lower limb orthopaedic surgery in the elderly.

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“…Total hip arthroplasty (THA) is a highly effective procedure for patients who have end-stage degenerative joint disease of the hip. [ 1 , 2 ] It was reported that over 300,000 THAs are being performed each year in the USA. [ 3 ] It is likely that the burden of inadequate postsurgical pain management associated with these procedures will also escalate.…”

Section: Introductionmentioning

confidence: 99%

Liposomal bupivacaine versus traditional bupivacaine for pain control after total hip arthroplasty

Ma¹,

Wang

Jiang³

et al. 2017

Medicine

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Background:In the past, the efficacy of local infiltration of liposomal bupivacaine for total hip arthroplasty (THA) patients was in debate. Therefore, this meta-analysis was conducted to determine whether local infiltration of liposomal bupivacaine provides better pain relief after THA.Methods:We searched Web of Science, PubMed, Embase, and the Cochrane Library databases to the April 2017. Any studies comparing liposomal bupivacaine and traditional bupivacaine were included in our meta-analysis. The outcomes included visual analog scale (VAS) at 24, 48, and 72 hours, total morphine consumption at 24 hours, and the length of hospital stay. We assessed the pooled data using a random-effect model.Results:Six studies were finally included in this meta-analysis. Our pooled data analysis demonstrated that liposomal bupivacaine was more effective than the traditional bupivacaine in terms of VAS at 24 hours (P = .018) and the length of hospital stay (P = .000). There was no significant difference in terms of the VAS at 48 and 72 hours and total morphine consumption at 24 hours (P >.05).Conclusion:Compared with the traditional bupivacaine, liposomal bupivacaine shows better pain control at 24 hours and reduces the length of hospital stay after THA. Its economic costs must be assessed in multimodal center randomized controlled trials when being recommended as a long-acting alternative analgesic agent for a THA patient.

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Comparison of analgaesia with lumbar epidurals and lumbar plexus nerve blocks in patients receiving multimodal analgaesics following primary total hip arthroplasty: a retrospective analysis

Cited by 7 publications

References 22 publications

Comparison of lateral quadratus lumborum and lumbar plexus blocks for postoperative analgesia following total hip arthroplasty: a randomized clinical trial

Comparison of lateral quadratus lumborum and lumbar plexus blocks for postoperative analgesia following total hip arthroplasty: a randomized clinical trial

Effects of Combined Spinal Epidural Anesthesia in Orthopaedic Surgery of Elderly Patients

Liposomal bupivacaine versus traditional bupivacaine for pain control after total hip arthroplasty

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