Total hip arthroplasty and peripheral nerve blocks: Limited but salient role?

Tyagi, Asha; Salhotra, Rashmi

doi:10.4103/joacp.joacp_114_18

Cited by 8 publications

(4 citation statements)

References 8 publications

(11 reference statements)

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“…Peripheral nerve blocks often have residual analgesic effect up to 24 h after surgery, this would reduce postoperative opioid requirement and may further reduce the risk of respiratory depression and falls [67,68]. The benefit of techniques such as neuraxial anesthesia, transverse abdominis plane (TAP) block, brachial plexus block and lower limb nerve blocks have been demonstrated consistently in a number of meta-analyses [69][70][71][72][73]. The efficacy of regional anesthesia could also be further augmented through the use of adjunct medications, such as dexmedetomidine [74] and dexamethasone [75].…”

Section: Choice Of Anesthesiamentioning

confidence: 99%

Frailty: the perioperative and anesthesia challenges of an emerging pandemic

et al. 2023

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Frailty is a complex and multisystem biological process characterized by reductions in physiological reserve. It is an increasingly common phenomena in the surgical population, and significantly impacts postoperative recovery. In this review, we will discuss the pathophysiology of frailty, as well as preoperative, intraoperative, and postoperative considerations for frailty care. We will also discuss the different models of postoperative care, including enhanced recovery pathways, as well as elective critical care admission. With discoveries of new effective interventions, and advances in healthcare information technology, optimized pathways could be developed to provide the best care possible that meets the challenges of perioperative frailty.

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Section: Choice Of Anesthesiamentioning

confidence: 99%

Frailty: the perioperative and anesthesia challenges of an emerging pandemic

et al. 2023

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“…A variety of nerve blocks are used for THA including lumbar plexus block, parasacral sciatic block, femoral nerve block, three-in-one block, and a quadratus lumborum block. 76 A study performed by Nishio et al has indicated that combination sciatic and femoral nerve block offers adequate analgesia, on the basis of reported pain scores at 6and 12-hour time points in patients undergoing THA. 77 Recent evidence has suggested that nerve block analgesia for patients after THA should be avoided in favor of systemic analgesia, owing to onset of low extremity weakness.…”

Section: Epidural Catheters and Peripheral Nerve Blocksmentioning

confidence: 99%

“…77 Recent evidence has suggested that nerve block analgesia for patients after THA should be avoided in favor of systemic analgesia, owing to onset of low extremity weakness. 76 Specifically, in up to 90% of cases following femoral nerve block or quadratus lumborum block, there is onset of significant quadriceps weakness, in which case the adverse consequences of falling may significantly outweigh the benefit of analgesia. 78 A study by Becker et al of elective THA patients undergoing either epidural or psoas nerve block showed that, on average, postoperative consumption of morphine was greater with the psoas nerve block (12.6mg) as compared to epidural (5.8mg).…”

Section: Epidural Catheters and Peripheral Nerve Blocksmentioning

confidence: 99%

Opioid Use Consequences, Governmental Strategies, and Alternative Pain Control Techniques Following Total Hip Arthroplasties

et al. 2022

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Over the last several decades, rates of opioid use and associated problems have dramatically increased in the United States leading to laws limiting prescription duration for acute pain management. As a result, orthopedic surgeons who perform total hip arthroplasty (THA), a procedure that often leads to significant postoperative pain, have been faced with substantial challenges to adequately mitigate patient pain while also reducing opioid intake. Current strategies include identifying and correcting modifiable risk factors associated with postoperative opioid use such as preoperative opioid use, alcohol and tobacco abuse, and untreated psychiatric illness. Additionally, recent evidence has emerged in the form of Enhanced Recovery After Surgery (ERAS) protocols suggesting that a multidisciplinary focus on patient factors perioperatively can lead to reduced postoperative opioid administration and decreased hospital stays. A cornerstone of ERAS protocols includes multimodal pain regimens with opioid rescue only as needed, which often includes multiple systemic pain therapies such as acetaminophen, gabapentin, non-steroidal anti-inflammatory drugs, as well as targeted pain therapies that include epidural catheters and ultrasound-guided nerve blocks. Many hospital systems and states have also implemented opioid prescribing limitations with mixed success. As the opioid epidemic continues in the United States, while contributing to poor outcomes following elective surgeries, further research is warranted to identify multidisciplinary strategies that mitigate opioid use while also allowing for adequate pain control and rehabilitation.

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“…Current pain control modalities following total hip arthroplasty include systemic analgesia (with and without opioids), neuraxial analgesia, peripheral nerve blocks (PNBs), and periarticular injection (PAI) [ 1 ]. PNBs are of unique interest as they have the potential to improve not only immediate postoperative pain but also long-term outcomes for patients, including lower risk of chronic post-surgical pain and improved function.…”

Section: Introductionmentioning

confidence: 99%

Periarticular Injection Versus Peripheral Nerve Blockade in Bilateral Total Hip Arthroplasty

Sivco¹,

Townsend²,

Leslie³

2023

Cureus

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Pain control after total hip arthroplasty is associated with patient satisfaction, early discharge, and improved surgical outcomes. Two commonly utilized opioid-reducing analgesic modalities are periarticular injection (PAI) by surgeons and motor-sparing peripheral nerve block (PNB) by anesthesiologists. We present a case contrasting PAI and PNB in a single patient undergoing bilateral total hip arthroplasty. For the left hip, the patient received preoperative transmuscular quadratus lumborum, femoral nerve, and lateral femoral cutaneous nerve blocks using a combination of low-concentration local anesthetic and glucocorticoids. For the right hip, the patient received an intraoperative PAI with liposomal bupivacaine. The patient's pain scores and recovery were evaluated for three months postoperatively. The patient's pain scores on postoperative day (POD) zero to five were consistently lower in the left hip than in the right hip. For this patient undergoing bilateral hip replacement, preoperative PNBs were superior to PAI for postoperative pain control.

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Total hip arthroplasty and peripheral nerve blocks: Limited but salient role?

Cited by 8 publications

References 8 publications

Frailty: the perioperative and anesthesia challenges of an emerging pandemic

Frailty: the perioperative and anesthesia challenges of an emerging pandemic

Opioid Use Consequences, Governmental Strategies, and Alternative Pain Control Techniques Following Total Hip Arthroplasties

Periarticular Injection Versus Peripheral Nerve Blockade in Bilateral Total Hip Arthroplasty

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