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

Marino, Joseph; Russo, Joseph; Kenny, Maureen E.; Herenstein, Robert; Livote, Elayne; Chelly, Jacques E.

doi:10.2106/jbjs.h.00079

Cited by 145 publications

(127 citation statements)

References 21 publications

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“…Complications have been described with the continuous lumbar nerve block including the possibility of a fall, leakage or failure of the catheter to work [20]. Others have reported the continuous catheter alone to help with mobilization and pain control after surgery [16]. The timing of surgery affected the administration of same-day rehabilitation, especially for a patient who had the procedure in the late afternoon period; surgery early in the day often meant more same-day rehabilitation sessions.…”

Section: Discussionmentioning

confidence: 99%

THA with a Minimally Invasive Technique, Multi-modal Anesthesia, and Home Rehabilitation: Factors Associated with Early Discharge?

Mears

Chelly

et al. 2009

Clin Orthop Relat Res

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Multimodal anesthetic and pain regimens with minimally invasive surgical approaches and rapid rehabilitation protocols are thought to decrease length of stay after hip replacement. We asked whether a program including these three elements could achieve 23-hour discharge in a group of 665 patients and whether the length of hospital stay was influenced by patient age, gender, body mass index, change in hemoglobin or estimated blood loss, duration of surgery (B 90 or [ 90 minutes

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Section: Discussionmentioning

confidence: 99%

THA with a Minimally Invasive Technique, Multi-modal Anesthesia, and Home Rehabilitation: Factors Associated with Early Discharge?

Mears

Chelly

et al. 2009

Clin Orthop Relat Res

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“…Effective treatment of postoperative pain is crucial to avoid impairment in mobility, adverse events, and prolonged hospitalization. Enhanced perioperative anesthesia protocols combining preemptive oral medication and the use of peripheral nerve blocks have been shown to improve patient satisfaction after hip arthroplasty and early postoperative rehabilitation [23,39].…”

Section: Introductionmentioning

confidence: 99%

Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis

Jiménez-Almonte

Wyles

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Local infiltration analgesia and peripheral nerve blocks are common methods for pain management in patients after THA but direct head-to-head, randomized controlled trials (RCTs) have not been performed. A network meta-analysis allows indirect comparison of individual treatments relative to a common comparator; in this case placebo (or no intervention), epidural analgesia, and intrathecal morphine, yielding an estimate of comparative efficacy. Questions/purposes We asked, when compared with a placebo, (1) does use of local infiltration analgesia reduce patient pain scores and opioid consumption, (2) does use of peripheral nerve blocks reduce patient pain scores and opioid consumption, and (3) is local infiltration analgesia favored over peripheral nerve blocks for postoperative pain management after THA? Methods We searched six databases, from inception through June 30, 2014, to identify RCTs comparing local infiltration analgesia or peripheral nerve block use in patients after THA. A total of 35 RCTs at low risk of bias based on the recommended Cochrane Collaboration risk assessment tool were included in the network meta-analysis (2296 patients). Primary outcomes for this review were patient pain scores at rest and cumulative opioid consumption, both assessed at 24 hours after THA. Because of substantial heterogeneity (variation of outcomes between studies) across included trials, a random effect model for meta-analysis was used to estimate the weighted mean difference (WMD) and 95% CI. The gray literature was searched with the same inclusion criteria as published One of the authors certifies that he (RJS), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000, from Biomet Inc (Warsaw, IN, USA 123Clin Orthop Relat Res (2016) 474:495-516 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® trials. Only one unpublished trial (published abstract) fulfilled our criteria and was included in this review. All other studies included in this systematic review were full published articles. Bayesian network meta-analysis included all RCTs that compared local infiltration analgesia or peripheral nerve blocks with placebo (or no intervention), epidural analgesia, and intrathecal morphine. Results Compared with placebo, local infiltration analgesia reduced patient pain scores (WMD, À0.61; 95% CI, À0.97 to À0.24; p = 0.001) and opioid consumption (WMD, À7.16 mg; 95% CI, À11.98 to À2.35; p = 0.004). Peripheral nerve blocks did not result in lower pain scores or reduced opioid consumption compared with placebo (WMD, À0.43; 95% CI, À0.99 to 0.12; p = 0.12 and WMD, À3.14 mg, 95% CI, À11.30 to 5.02; p = 0.45). However, network meta-analysis comparing local infiltration analgesia with peripheral nerve blocks through common comparators showed no differences between postoperative pain scores (WMD, À0.36; 95% CI, À1.06 to 0.31) and opioid consumption (WMD, À4....

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“…Marino et al [14] conducted a randomized controlled trial to compare continuous LPB with femoral nerve block and concluded that continuous LPB is a more effective analgesic modality than a continuous femoral block or patient-controlled intravenous administration of hydromorphone alone during physical therapy after primary unilateral THA. Siddiqui et al [19] came to a similar conclusion that continuous perioperative LPB provides superior analgesia Values are expressed as mean ± SD; PVB = paravertebral block; LPB = lumbar plexus block.…”

Section: Discussionmentioning

confidence: 99%

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

Wardhan

Auroux

Ben‐David

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background 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. Questions/purposes 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. Methods 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. Results 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. Conclusions 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.

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

Cited by 145 publications

References 21 publications

THA with a Minimally Invasive Technique, Multi-modal Anesthesia, and Home Rehabilitation: Factors Associated with Early Discharge?

THA with a Minimally Invasive Technique, Multi-modal Anesthesia, and Home Rehabilitation: Factors Associated with Early Discharge?

Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis

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

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