Effects of Epidural Analgesia and Continuous Lumbar Plexus Block on Functional Rehabilitation after Total Hip Arthroplasty

Duarte, Leonardo Teixeira Domingues; Beraldo, Paulo Sérgio Siebra; Saraiva, Renato Ângelo

doi:10.1016/s0034-7094(09)70078-9

Cited by 9 publications

(13 citation statements)

References 25 publications

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“…However, these results also differ from other studies. Duarte et al 3 have reported that patient The incidence of complications for both groups is shown in table 2. cLPB group had a total number of complications significantly lower as compared to the epidural group (4.7% cLPB versus 23.4% epidural). However, the scarce incidence of each complication does not allow establishing statistically significant differences between groups.…”

Section: Discussionmentioning

confidence: 92%

“…Unfortunately, the low incidence of secondary effects and complications in the sample does not allow inferring the existence of significant differences between cLPB and epidural techniques. cLPB seldom has severe complications being known intoxication by local anesthetics following inadvertent intravascular injections, spinal administration, intraperitoneal puncture, subcapsular renal hematoma by renal perforation and retroperitoneal hematoma 1,3,5 . Drug dispersion to the epidural space was considered by other authors as the most frequent LPB complication, with incidence of 5% 4,5,10 .…”

Section: Discussionmentioning

confidence: 99%

“…Patients' recovery requires effective analgesia to assure comfort and satisfaction necessary for early mobilization and functional rehabilitation. So, adequate THA analgesia speeds recovery and minimizes postoperative morbility-mortality [1][2][3] . Different analgesic techniques to provide post-THA pain relief were studied, such as intravenous patient-controlled analgesia (PCA) with opioids, epidural analgesia, peripheral nerves block and lumbar plexus block (LPB).…”

Section: Justificatica E Objetivosmentioning

confidence: 99%

“…Most common postoperative THA analgesia is the epidural block, although presenting known adverse effects, such as hypotension, nausea, vomiting, pruritus, urinary retention, motor block and respiratory depression. Peripheral nerves block provides excellent analgesia with little motor and sympathetic blocks, preventing adverse effects of local anesthetics and opioids administered to the neuraxis 3 . Recently, LPB started to receive more attention as THA analgesic technique [1][2][3] .…”

Section: Justificatica E Objetivosmentioning

confidence: 99%

“…Peripheral nerves block provides excellent analgesia with little motor and sympathetic blocks, preventing adverse effects of local anesthetics and opioids administered to the neuraxis 3 . Recently, LPB started to receive more attention as THA analgesic technique [1][2][3] . Lumbar plexus is responsible for skin sensitivity in the side of the thigh and originates some branches to the hip 4 .…”

Section: Justificatica E Objetivosmentioning

confidence: 99%

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

Costa¹,

Carvalho²,

Castro³

et al. 2016

Revista Dor

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BACKGROUND AND OBJECTIVES:Postoperative pain after total hip arthroplasty is moderate to severe and requires effective analgesic techniques. This study aimed at comparing continuous lumbar plexus block and epidural analgesia in patients submitted to hip arthroplasty. METHODS: This is a prospective, observational and analytical study of patients submitted to hip arthroplasty in a two-year period, under postoperative analgesia with continuous lumbar plexus block and epidural analgesia. Patients were divided according to the analgesic technique chosen by the anesthesiologist. The protocol consists in continuous perfusion of 0.2% ropivacaine (5mL/h) via continuous lumbar plexus block catheter or 0.1% ropivacaine and fentanyl (3µg/mL) (5mL/h) via epidural catheter. Using Acute Pain Unit records, three postoperative days were compared between continuous lumbar plexus block and epidural analgesia with regard to pain intensity, rescue analgesia, complications and hospital stay. RESULTS: Participated in the study 162 patients. Most patients of both groups had no pain in the first postoperative day (77.6% continuous lumbar plexus block versus 79.2% epidural). Both groups were not different with regard to pain intensity and need for rescue analgesia (23.5% continuous lumbar plexus block versus 22.1% epidural). Continuous lumbar plexus block group had fewer complications (4.7% versus 23.4%), namely motor block, nausea, vomiting and itching. The low number of complications does not allow the detection of significant differences between techniques. Most patients of both groups were discharged in the third postoperative day. Postoperative analgesia for hip arthroplasty: comparison of continuous lumbar plexus block and epidural analgesia

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Justificatica E Objetivosmentioning

confidence: 99%

Section: Justificatica E Objetivosmentioning

confidence: 99%

Section: Justificatica E Objetivosmentioning

confidence: 99%

See 3 more Smart Citations

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

Costa¹,

Carvalho²,

Castro³

et al. 2016

Revista Dor

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

Wilson

Wolf

Algendy

et al. 2017

The Journal of Arthroplasty

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Effects of Epidural Analgesia and Continuous Lumbar Plexus Block on Functional Rehabilitation after Total Hip Arthroplasty

Abstract: The greater effectivity of epidural analgesia did not translate in improvement of the rehabilitation process nor did it decrease the time necessary to achieve end goals.

Cited by 9 publications

References 25 publications

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

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

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

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

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