Posterior Lumbar Plexus Block in Postoperative Analgesia for Total Hip Arthroplasty. A Comparative Study between 0.5% Bupivacaine with Epinephrine and 0.5% Ropivacaine

Duarte, Leonardo Teixeira Domingues; Paes, Franklin Cespedes; Fernandes, Maria do Carmo Barreto de C.; Saraiva, Renato Ângelo

doi:10.1590/s0034-70942009000300002

Cited by 10 publications

(4 citation statements)

References 26 publications

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“…All studies mentioning LIA reported intraoperative periarticular, capsular and subcutaneous infiltration, whereas some added to that approach a postoperative intra-articular infiltration, 16,18,19,47,66 a postoperative periarticular infiltration, 46 or a periarticular infiltration with catheters. 15,73 Only long-acting local anaesthetics were used as the basis for LIA, those being ropivacaine, [15][16][17][18][19][20]30,39,46,47,49,50,52,60,73,[77][78][79]85 bupivacaine, 40 or levobupivacaine. 32,58,66 Supplementary Table S1 summarises the LIA techniques used.…”

Section: Analgesic Interventionsmentioning

confidence: 99%

Procedure-specific acute pain trajectory after elective total hip arthroplasty: systematic review and data synthesis

Panzenbeck

Keudell

Joshi

et al. 2021

British Journal of Anaesthesia

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Background: For most procedures, there is insufficient evidence to guide clinicians in the optimal timing of advanced analgesic methods, which should be based on the expected time course of acute postoperative pain severity and aimed at time points where basic analgesia has proven insufficient. Methods: We conducted a systematic search of the literature of analgesic trials for total hip arthroplasty (THA), extracting and pooling pain scores across studies, weighted for study size. Patients were grouped according to basic anaesthetic method used (general, spinal), and adjuvant analgesic interventions such as nerve blocks, local infiltration analgesia, and multimodal analgesia. Special consideration was given to high-risk populations such as chronic pain or opioid-dependent patients. Results: We identified and analysed 71 trials with 5973 patients and constructed pain trajectories from the available pain scores. In most patients undergoing THA under general anaesthesia on a basic analgesic regimen, postoperative acute pain recedes to a mild level (<4/10) by 4 h after surgery. We note substantial variability in pain intensity even in patients subjected to similar analgesic regimens. Chronic pain or opioid-dependent patients were most often actively excluded from studies, and never analysed separately. Conclusions: We have demonstrated that it is feasible to construct procedure-specific pain curves to guide clinicians on the timing of advanced analgesic measures. Acute intense postoperative pain after THA should have resolved by 4e6 h after surgery in most patients. However, there is a substantial gap in knowledge on the management of patients with chronic pain and opioid-dependent patients.

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Section: Analgesic Interventionsmentioning

confidence: 99%

Procedure-specific acute pain trajectory after elective total hip arthroplasty: systematic review and data synthesis

Panzenbeck

Keudell

Joshi

et al. 2021

British Journal of Anaesthesia

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“…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%

“…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%

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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“…Despite impressive advances in anesthesiological and surgical techniques, morbidity and mortality in patients with severe aortic stenosis remains high [1]. Patients undergoing hip arthroplasty usually are elderly and present with different associated comorbidities [2]. We report successful management of a patient with aortic stenosis, hypertension, cerebrovascular disease, and a temporary pacemaker who underwent hip fracture surgery.…”

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confidence: 99%

Combined lumbar plexus and sciatic nerve block for hip fracture surgery in a patient with severe aortic stenosis

et al. 2011

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In the elderly population, the prevalence of symptomatic cardiac disease, including aortic stenosis, is increased. Despite impressive advances in anesthesiological and surgical techniques, morbidity and mortality in patients with severe aortic stenosis remains high [1]. Patients undergoing hip arthroplasty usually are elderly and present with different associated comorbidities [2]. We report successful management of a patient with aortic stenosis, hypertension, cerebrovascular disease, and a temporary pacemaker who underwent hip fracture surgery.A 75-year-old woman (60 kg, 155 cm) had fallen, resulting in a closed fracture of the right trochanter. She had cerebrovascular disease, aortic stenosis, and hypertension. Preoperative physical examination revealed findings consistent with her valvular heart disease and cardiac pulse of 35/min; the electrocardiogram showed complete atrioventricular (AV) block and left ventricular hypertrophy. A temporary pacemaker had been placed. The echocardiogram revealed an aortic valve area of 1 cm 2 and concentric left ventricular hypertrophy. Aortic valve pressure gradient was 40 mmHg. We decided that one of the best anesthetic procedures for her was combined lumbar plexus and sciatic nerve blockade, which would provide stable hemodynamic parameters. Combined paravertebral lumbar plexus and sciatic nerve block produces adequate anesthesia of the ipsilateral lower limb for surgical repair of hip fracture in the elderly [3].In the operating room, lumbar plexus block was performed using the Chayen's approach [4]. In brief, the patient was turned to the left lateral position with right hip and knee flexed to approximately 45°. A puncture point was identified 4 cm lateral from midline of the L5 spinous process along the intercristal line. A 110-mm, 22-G stimulating needle (Contiplex D; B. Braun, Melsungen, Germany) connected to a nerve stimulator (Stimuplex HNS 11, B. Braun) was advanced perpendicular to all planes, and a motor stimulus was seen in the quadriceps distribution. Sciatic nerve blockade was performed using the classic Labat's approach [5]. Briefly, the needle was inserted 5 cm below the midpoint of a line connecting the posterior superior iliac spine and the greater trochanter. After an appropriate stimulus was localized in the sciatic distribution, 10 ml levobupivacaine 0.25% was injected and the patient was returned to the supine position. Combined block developed in approximately 30 min for qualitative anesthesia. Her blood pressure was between 160/100 and 110/70 mmHg throughout the 60 min of surgery. Estimated blood loss and intraoperative urine output were 250 and 200 ml, respectively, and 1,000 ml of lactated Ringer's solution was administered. Following surgery she was taken to the postanesthesia care unit. The effective time of the nerve blocks was 20 h. She was discharged from hospital 6 days after her operation.General anesthesia could have been an option in our patient. However, general anesthetic agents can depress the myocardium, produce vasodilatation, and can...

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Posterior Lumbar Plexus Block in Postoperative Analgesia for Total Hip Arthroplasty. A Comparative Study between 0.5% Bupivacaine with Epinephrine and 0.5% Ropivacaine

Abstract: 0.5% Bupivacaine and 0.5% ropivacaine produced effective and prolonged postoperative pain relief after total hip arthroplasty, without clinical differences, when equivalent doses were administered for posterior lumbar plexus block.

Cited by 10 publications

References 26 publications

Procedure-specific acute pain trajectory after elective total hip arthroplasty: systematic review and data synthesis

Procedure-specific acute pain trajectory after elective total hip arthroplasty: systematic review and data synthesis

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

Combined lumbar plexus and sciatic nerve block for hip fracture surgery in a patient with severe aortic stenosis

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