Continuous Versus Single-Injection Lumbar Plexus Blocks: Comparison of the Effects on Morphine Use and Early Recovery After Total Knee Arthroplasty

Watson, M. J.; Mitra, Dalia; McLintock, Traven C.; Grant, Stuart A.

doi:10.1016/j.rapm.2005.06.006

Cited by 22 publications

(13 citation statements)

References 18 publications

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“…One study demonstrated a significant increase in obturator motor blockade at 6 hours postoperatively [33]. Urinary retention was registered in one trial [35], cardiac events in one [38] and hypotension in two [35, 37]. No significant differences between active and control groups were reported.…”

Section: Resultsmentioning

confidence: 99%

Postoperative pain treatment after total knee arthroplasty: A systematic review

et al. 2017

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IntroductionThe aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA).MethodsThis PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-based analgesic interventions after TKA. Bias was evaluated according to Cochrane methodology. Outcomes were opioid consumption (primary), pain scores at rest and during mobilization, adverse events, and length of stay. Interventions investigated in three or more trials were meta-analysed. Outcomes were evaluated using forest plots, Grading of Recommendations Assessment, Development and Evaluation (GRADE), L’Abbe Plots and trial sequential analysis.ResultsThe included 113 trials, investigating 37 different analgesic interventions, were characterized by unclear/high risk of bias, low assay sensitivity and considerable differences in pain assessment tools, basic analgesic regimens, and reporting of adverse events. In meta-analyses single and continuous femoral nerve block (FNB), intrathecal morphine, local infiltration analgesia, intraarticular injection of local anaesthetics, non-steroidal anti-inflammatory drugs, and gabapentinoids demonstrated significant analgesic effects. The 24-hour morphine-sparing effects ranged from 4.2 mg (CI: 1.3, 7.2; intraarticular local anaesthetics), to 16.6 mg (CI: 11.2, 22; single FNB). Pain relieving effects at rest at 6 hours ranged from 4 mm (CI: -10, 2; gabapentinoids), to 19 mm (CI: 8, 31; single FNB), and at 24 hours from 3 mm (CI: -2, 8; gabapentinoids), to 16 mm (CI: 8, 23; continuous FNB). GRADE-rated quality of evidence was generally low.ConclusionA low quality of evidence, small sample sizes and heterogeneity of trial designs prohibit designation of an optimal procedure-specific analgesic regimen after TKA.

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Section: Resultsmentioning

confidence: 99%

Postoperative pain treatment after total knee arthroplasty: A systematic review

et al. 2017

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“…Femoral or posterior lumbar plexus infusions are well validated for hip [158, 187, 206, 207] and knee surgery in RCTs [208–210] but might result in dangerous quadriceps femoris and hip adductor weakness if high doses of local anesthetic are administered to optimize analgesia [178]. Moreover, contrary to the brachial plexus, in the lower extremity a single perineural infusion will not cover all surgical sites as these are innervated by multiple nerves.…”

Section: Why Cpnb Instead Of Spnb?mentioning

confidence: 99%

The Role of Continuous Peripheral Nerve Blocks

Aguirre

Moral

Cobo

et al. 2012

Anesthesiology Research and Practice

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A continuous peripheral nerve block (cPNB) is provided in the hospital and ambulatory setting. The most common use of CPNBs is in the peri- and postoperative period but different indications have been described like the treatment of chronic pain such as cancer-induced pain, complex regional pain syndrome or phantom limb pain. The documented benefits strongly depend on the analgesia quality and include decreasing baseline/dynamic pain, reducing additional analgesic requirements, decrease of postoperative joint inflammation and inflammatory markers, sleep disturbances and opioid-related side effects, increase of patient satisfaction and ambulation/functioning improvement, an accelerated resumption of passive joint range-of-motion, reducing time until discharge readiness, decrease in blood loss/blood transfusions, potential reduction of the incidence of postsurgical chronic pain and reduction of costs. Evidence deriving from randomized controlled trials suggests that in some situations there are also prolonged benefits of regional anesthesia after catheter removal in addition to the immediate postoperative effects. Unfortunately, there are only few data demonstrating benefits after catheter removal and the evidence of medium- or long-term improvements in health-related quality of life measures is still lacking. This review will give an overview of the advantages and adverse effects of cPNBs.

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“…A CLPB with a sciatic block decreased pain when compared to a PCA 34 and even was shown to be as effective as an epidural. 35 One study using ropivacaine did not show a difference in analgesia between a CLPB versus SSLPB when both were combined with a sciatic block, 36 although another study using levobupivacaine that also used a placebo infusion did demonstrate improved pain control with a CLPB versus SSLPB 37 (Table 1, References 38 and 39, regarding TKA but not included in the text).…”

Section: Resultsmentioning

confidence: 99%

Preventive Analgesia by Local Anesthetics

Barreveld

Witte

Chahal³

et al. 2013

Anesthesia &Amp; Analgesia

142

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The use of local anesthetics to reduce acute postoperative pain has a long history, but recent reports have not been systematically reviewed. In addition, the need to include only those clinical studies that meet minimum standards for randomization and blinding must be adhered to. In this review we have applied stringent clinical study design standards to identify publications on the use of perioperative local anesthetics. We first examined several types of peripheral nerve blocks, covering a variety of surgical procedures, and second, for effects of intentionally administered IV local anesthetic (lidocaine) for suppression of postoperative pain. Thirdly, we have examined publications in which vascular concentrations of local anesthetics were measured at different times after peripheral nerve block procedures, noting the incidence when those levels reached ones achieved during intentional IV administration. Importantly, the very large number of studies using neuraxial blockade techniques (epidural, spinal) has not been included in this review but will be dealt with separately in a later review. The overall results showed a strongly positive effect of local anesthetics, by either route, for suppressing postoperative pain scores and analgesic (opiate) consumption. In only a few situations were the effects equivocal. Enhanced effectiveness with the addition of adjuvants was not uniformly apparent. The differential benefits between drug delivery before, during, or immediately after a surgical procedure are not obvious, and a general conclusion is that the significant antihyperalgesic effects occur when the local anesthetic is present during the acute postoperative period, and its presence during surgery is not essential for this action.

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Continuous Versus Single-Injection Lumbar Plexus Blocks: Comparison of the Effects on Morphine Use and Early Recovery After Total Knee Arthroplasty

Abstract: Postoperative infusion of local anesthetic around the lumbar plexus reduces morphine requirement and improves early recovery after total knee arthroplasty as compared with a single-injection block.

Cited by 22 publications

References 18 publications

Postoperative pain treatment after total knee arthroplasty: A systematic review

Postoperative pain treatment after total knee arthroplasty: A systematic review

The Role of Continuous Peripheral Nerve Blocks

Preventive Analgesia by Local Anesthetics

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