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

Abstract

In comparison to lumbar epidural catheters, lumbar plexus nerve blocks are an effective pathway for postoperative pain control following primary THA. Furthermore, this clinical pathway expedites physical rehabilitation and is more compatible with postoperative prophylactic anticoagulants.

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

“…Patients who received lumbar epidural analgaesia ambulated an average of 7.4 hours later than those receiving a lumbar plexus block in a multivariable analysis. These findings are consistent with past publications noting that lumbar plexus blocks promote ambulation following THA [14,15]. Additionally, past comparisons of lumbar plexus blocks to lumbar epidurals have noted improved ambulation distances with decreased assistance.…”

“…However, in a multivariable model, lumbar plexus blocks were associated with decreased opiate consumption at 24-36 and 36-48 hours post-operatively. A similarly designed retrospective publication comparing lumbar plexus and lumbar epidural infusions after primary THA also found lumbar plexus nerve blocks to decrease opiate consumption 12-to 48 hours post-operatively [15]. However, that study did not standardise the oral administration of nonopiate analgaesics.…”

“…In contrast, lumbar plexus nerve blocks also reduce post-operative pain after THA while avoiding some side effects common to neuraxial analgaesia [10,13,14]. A recent, retrospective study noted lumbar plexus blocks provide post-operative analgaesia comparable with CEA [15]. However, a limitation to this study was the lack of standardisation for oral administration of nonopiate analgaesics between block groups.…”

“…Based on a prior study [15], 48-h morphine equivalent consumption IV in the lumbar plexus group was anticipated to be 64 mg ± 7 mg. A sample size of 24 per group was needed to provide >90% power to detect a consumption difference of 7.0 mg assuming a standard deviation (SD) in both groups of 7 mg (α = 0.05) using a two-sided Mann-Whitney test.…”

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

“…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.…”