Background:
The clinical outcomes (time to ambulation, length of stay, and home discharge) after proximal femoral nail (PFN) for proximal femoral fractures (PFF) is dependent on successful pain management. Currently, the lumbar erector spinae plane block (LESPB) is in vogue and is associated with favorable outcomes in the postoperative period. Our study aimed to evaluate whether a LESPB provided equivalent analgesia and clinical outcomes as compared to LPB in PFN for PFF.
Material and Methods:
We compared LPBs [L] with LESPBs [E], with 30 patients in each group, performed from June 2020 to June 2021 for PFN in PFF's. The primary outcome of this study was the average NRS pain scores over 24 hours postoperatively. Secondary outcomes included pain scores at different time points over 24 hours, opioid consumption between the groups at 24 hours postoperatively, time for request of first parenteral analgesia, quadriceps weakness and adverse events.
Results:
The average pain scores over 24 hours were better in the LESPB group as compared to the LPB group (
p
= 0.02). Further, only n = 5 (30%) of patients in the LESPB group required opioids, while n = 13 (43.333%) of patients in the LPB group required opioids. Moreover, the median time for request of first parenteral analgesia was 615 (480–975) minutes, weakness of quadriceps function occurred in 2 patients in the L group, which recovered at 3
rd
and 5
th
month, respectively, with no incidences of hemodynamic instability and respiratory complications.
Conclusions:
This trial demonstrated that single bolus LESPB is superior to LPB in terms of analgesic outcomes, has low adverse events, and is an agreeable substitute for patients with PFF undergoing a PFN.
The brachial plexus blocks (BPBs) are routinely performed for all surgeries in the vicinity of the elbow joint. Phrenic nerve paresis is a major problem with above-clavicle blocks especially the interscalene approach. The primary aim of this pilot study was to assess feasibility and to evaluate if perioperative pain management with the articular and cutaneous nerve block, the peri-humeral block (PHB) resulted in decreased use of opioid consumption in the intraoperative and postoperative period for the first 24 hours. Twenty-four patients with distal humerus fracture received ultrasound (US)-guided PHB as part of their perioperative anesthetic management. The primary aim was to evaluate block efficacy in terms of time to first analgesia and opioid consumption in first 24 hours. US in real time revealed that in all patients the local anesthetic was optimally deposited. Due to a stable intraoperative hemodynamics, none of the patients required additional opioid doses. The median pain scores over 24 hours were 2.4 with IQR (0-3.8). The mean time to first analgesic was 425.417 ± 229.005 min. There were no adverse effects reported at the time of hospital discharge. Though the US-guided PHB would not replace the BPB, in some special circumstances, it would be desirable to implement the former block which has opioid and motor sparing features and incorporate with multimodal analgesia.
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