A retrospective review of lumbar epidural and lumbar plexus nerve blocks for patients undergoing primary total hip arthroplasty and receiving multimodal analgesics

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Auteurs
Catégorie Primary study
JournalRegional Anesthesia and Pain Medicine
Year 2016
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Introduction Total hip arthroplasty (THA) is associated with significant postoperative pain. Both lumbar epidurals and lumbar plexus nerve blocks (LPNB) have been described for postoperative pain control after THA [1-4], but existing studies have not compared these techniques. Materials and methods (NA for case report) After institutional review board approval, a retrospective cohort of 48 patients meeting inclusion criteria was randomly selected using electronic medical records. All received perioperative oral multimodal analgesia. Half (n=24) received epidurals for postoperative pain management and the other half (n=24) received single injection LPNB. Postoperative opiate consumption in morphine equivalents (ME) at 48 hours was the primary endpoint. Time to first ambulation, ambulation distance, level of assistance with ambulation, and time to discharge orders were secondary endpoints. Descriptive statistics were calculated to characterize subjects in the different block type groups. Comparisons in opiate consumption were evaluated with linear mixed models. Primary and secondary endpoints were examined in multivariable models. Results/Case report The variables considered in the multivariable model include total ME given in the OR, age, block type, time, and the interaction between block type and time. Significant differences existed between block types at 36 and 48 hours. Patients with an epidural consumed 62% more morphine between 24-36 hours than patients with a LPNB after controlling for amount of morphine received in the OR (P = 0.037, 95% CI = 4.4-119%). Patients with an epidural consumed 69% more morphine between 36-48 hours than patients with a LPNB after controlling for amount of morphine received in the OR (P = 0.020, 95% CI = 11.4-126%). Time to first ambulation was significantly associated with the block type received and presence of dizziness within the first 24 hours postoperatively (P = 0.043 and 0.014, respectively). After controlling for dizziness, patients that received an epidural ambulated 7.4 hours later. Distance ambulated, level of assistance with ambulation, and time to discharge orders did not differ between groups. Discussion This retrospective study comparing lumbar and LPNBs for primary THA demonstrated that opiate consumption was similar between the two groups for the first 24 hours postoperatively. However, the LPNB group consumed less ME from hours 24-48 and ambulated earlier. These findings suggest that LPNBs provide comparable analgesia to lumbar epidurals for the first 24 hours after THA. Additionally, VTE prophylaxis initiation required epidural catheter removal on postoperative day one resulting in a substantial increase in opiate consumption. Since early postoperative physical therapy has been demonstrated as an important factor for continued rehabilitative success after THA, secondary endpoints related to functional recovery were examined. Patients receiving LPNBs were found to ambulate earlier than patients with epidurals and this persisted after controlling for dizziness. Compared with lumbar epidurals, LPNBs can provide effective analgesia for THA, avoid anticoagulation conflicts with VTE prophylaxis, and promote functional rehabilitation.
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First added on: Feb 08, 2025