Continuous Lumbar Plexus Block Provides Improved Analgesia With Fewer Side Effects Compared With Systemic Opioids After Hip Arthroplasty: A Randomized Controlled Trial

Siddiqui, Zafar I.; Cepeda, M. Soledad; Denman, William T.; Schumann, Roman; Carr, Daniel B.

doi:10.1016/j.rapm.2007.04.008

Cited by 46 publications

(60 citation statements)

References 14 publications

(14 reference statements)

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“…Early rehabilitation decreases postoperative pain and improves function and self-efficacy [10,39]. Revised anesthesia protocols with emphasis on regional and local approach in the form of peripheral nerve blocks, PCB, LPB, and local infiltration techniques have reduced nausea and vomiting and shortened hospital stay [2,4,21,42,44,58]. Aggressive pain control with revised anesthesia protocols improves participation in postoperative rehabilitation [45].…”

Section: Discussionmentioning

confidence: 99%

“…The patients receiving cPCB did better in all the parameters [4]. Siddiqui et al [58] published a prospective study of 34 patients undergoing THA under general anesthesia who were randomized to continuous lumbar plexus block (cLPB) combined with PCA or PCA alone for postoperative pain. Patients in the cLPB group required less morphine (12 mg) (95% CI, 12.9 to 3.9), had on average less pain (2.1 units on a 0-10 scale) (95% CI, 3.8 to 1.1), were more satisfied with their analgesic technique, and experienced less nausea and vomiting [58].…”

Section: Aggressive Pain Management With Multimodal Approach and Revimentioning

confidence: 99%

“…Siddiqui et al [58] published a prospective study of 34 patients undergoing THA under general anesthesia who were randomized to continuous lumbar plexus block (cLPB) combined with PCA or PCA alone for postoperative pain. Patients in the cLPB group required less morphine (12 mg) (95% CI, 12.9 to 3.9), had on average less pain (2.1 units on a 0-10 scale) (95% CI, 3.8 to 1.1), were more satisfied with their analgesic technique, and experienced less nausea and vomiting [58]. Andersen et al [2] studied 80 patients undergoing elective THA under spinal block who were randomly assigned to receive either (1) continuous epidural infusion or (2) infiltration around the hip joint with a mixture of 100 mL ropivacaine 2 mg/mL, 1 mL ketorolac 30 mg/mL, and 1 mL epinephrine 0.5 mg/mL at the conclusion of surgery combined with one postoperative intraarticular injection of the same substances through an intraarticular catheter.…”

Section: Aggressive Pain Management With Multimodal Approach and Revimentioning

confidence: 99%

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Factors Influencing Early Rehabilitation After THA: A Systematic Review

Sharma

Morgan

Cheng

2009

Clin Orthop Relat Res

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A wide variation exists in rehabilitation after total hip arthroplasty (THA) in part due to a paucity of evidence-based literature. We asked whether a minimally invasive surgical approach, a multimodal approach to pain control with revised anesthesia protocols, hip restrictions, or preoperative physiotherapy achieved a faster rehabilitation and improved immediate short-term outcome. We conducted a systematic review of 16 level I and II studies after a strategy-based search of English literature on OVID Medline, PubMed, CINAHL, Cochrane, and EMBASE databases. We defined the endpoint of assessment as independent ambulation and ability to perform activities of daily living. Literature supports the use of a multimodal pain control to improve patient compliance in accelerated rehabilitation. Multimodal pain control with revised anesthesia protocols and accelerated rehabilitation speeds recovery after minimally invasive THA compared to the standard approach THA, but a smaller incision length or minimally invasive approach does not demonstrably improve the short-term outcome. Available studies justify no hip restrictions following an anterolateral approach but none have examined the question for a posterior approach. Preoperative physiotherapy may facilitate faster postoperative functional recovery but multicenter and welldesigned prospective randomized studies with outcome measures are necessary to confirm its efficacy.

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Section: Discussionmentioning

confidence: 99%

Section: Aggressive Pain Management With Multimodal Approach and Revimentioning

confidence: 99%

Section: Aggressive Pain Management With Multimodal Approach and Revimentioning

confidence: 99%

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Factors Influencing Early Rehabilitation After THA: A Systematic Review

Sharma

Morgan

Cheng

2009

Clin Orthop Relat Res

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“…Continuous lumbar plexus block has been shown to provide improved analgesia and patient satisfaction with fewer side effects compared to systemic opioids in both hip and knee arthroplasties [6,7] . There is no evidence of clear benefit in terms of early recovery, length of stay or morphine use when using continuous versus single-injection lumbar plexus block as an adjunct to knee arthroplasty [10,11] .…”

Section: Discussionmentioning

confidence: 99%

“…Arterial blood gas analysis on admission showed pH 7.44, pCO 2 8.33kPa, pO 2 6.46kPa, bicarbonate 37.7mmol, BE +14.2 on breathing room air. Admission bloods showed haemoglobin (Hb) 11.1(g%), WCC 25.0 (10 3 ), platelets 295 (10 9 ), Na + 139mmol, K + 4.0mmol, urea 7.5mmol, creatinine 94mmol, normal LFTs, PT 12.8Sec and aPTT 21.8Sec.…”

mentioning

confidence: 99%

Safety of combined lumbar and sacral plexus block in high risk patients undergoing fractured neck of femur repair under general anaesthesia

Dixit

Banerjee

Singh

2014

CRIM

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In this case series we present three high-risk patients with multiple co-morbidities listed for repair of fractured neck of femur with hemiarthroplasty under general anaesthesia. All three were administered combined unilateral lumbar plexus block (LPB) and sacral plexus block (SPB) for intra and post-operative analgesia. One patient presented with severe chronic obstructive pulmonary disease in combination with severe aortic stenosis. The second one had extensive medical history, was in fast atrial fibrillation (AF) and was actively taking clopidogrel. The last patient had an automatic implantable cardioverter defibrillator (AICD) for dilated cardiomyopathy secondary to ischaemic heart disease and was in left ventricular failure. All three patients had uneventful recovery and were discharged to the ward following their initial stay in the critical care unit. We discuss the evidence and controversies surrounding the techniques employed in these three difficult cases.

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Regional and Multimodal Analgesia to Reduce Opioid Use after Total Joint Arthroplasty: A Narrative Review

Soffin

2019

HSS Journal®

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Background Elective total joint arthroplasty may be a gateway to long-term opioid use. Questions/Purpose We sought to review the literature on multimodal and regional analgesia as a strategy to minimize perioperative opioid use and control pain in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Methods We conducted a narrative review to assess the state of the evidence informing opioid-sparing analgesics for THA and TKA. A PubMed search was conducted for English-language articles published before April 2018. We preferentially included well-designed randomized controlled trials, systematic reviews, and meta-analyses. Where the highest levels of evidence were not yet apparent, we evaluated retrospective and/or observational studies. Results Multimodal analgesia emphasizing nonsteroidal anti-inflammatory agents and acetaminophen is associated with decreases in perioperative opioid use for THA and TKA. Regional analgesia, including peripheral nerve blocks and local infiltration analgesia, is also associated with decreased perioperative opioid use for THA and TKA. Emerging topics in post-arthroplasty analgesia include (1) the value of nonsteroidal anti-inflammatory drugs, (2) the use of peripheral nerve catheters and extended-release local anesthetics to prolong the duration of opioid-free analgesia, and (3) novel peripheral nerve blocks, exemplified by the IPACK (interspace between the popliteal artery and posterior capsule of the knee) block for TKA. Conclusions The use of multimodal analgesia with regional techniques may decrease perioperative opioid use for patients undergoing THA and TKA. These techniques should be part of a comprehensive perioperative plan to promote adequate analgesia while minimizing overall opioid exposure.

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Continuous Lumbar Plexus Block Provides Improved Analgesia With Fewer Side Effects Compared With Systemic Opioids After Hip Arthroplasty: A Randomized Controlled Trial

Cited by 46 publications

References 14 publications

Factors Influencing Early Rehabilitation After THA: A Systematic Review

Factors Influencing Early Rehabilitation After THA: A Systematic Review

Safety of combined lumbar and sacral plexus block in high risk patients undergoing fractured neck of femur repair under general anaesthesia

Regional and Multimodal Analgesia to Reduce Opioid Use after Total Joint Arthroplasty: A Narrative Review

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