Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty

Robert David Stevens, Elisabeth Van Gessel, Nicolas Flory, Roxane Foumier, Zdravko Gamulin

Research output: Contribution to journalArticle

Abstract

Background: The usefulness of peripheral nerve blockade in the anesthetic management of hip surgery has not been clearly established. Because sensory afferents from the hip include several branches of the lumbar plexus, the authors hypothesized that a lumbar plexus block could reduce pain from a major hip procedure. Methods: In a double-blind prospective trial, 60 patients undergoing total hip arthroplasty were randomized to receive general anesthesia with (plexus group, n = 30) or without (control group, n = 30) a posterior lumbar plexus block. The block was performed after induction using a nerve stimulator, and 0.4 ml/kg bupivacaine, 0.5%, with epinephrine was injected. General anesthesia was standardized, and supplemental fentanyl was administered per hemodynamic guidelines. Postoperative pain and patient- controlled intravenous morphine use were serially assessed for 48 h. Results: The proportion of patients receiving supplemental fentanyl intraoperatively was more than 3 times greater in the control group (20 of 30 vs. 6 of 29, P = 0.001). In the postanesthesia care unit, a greater than fourfold reduction in pain scores was observed in the plexus group (visual analogue scale [VAS] pain score at arrival 1.3 ± 2 vs. 5.6 ± 3, P <0.001), and 'rescue' morphine boluses (administered if VAS > 3) were administered 10 times less frequently (in 2 of 28 vs. in 22 of 29 patients, P <0.0001). Pain scores and morphine consumption remained significantly lower in the plexus group until 6 h after randomization (VAS at 6 h, 1.4 ± 1.3 vs. 2.4 ± 1.4, P = 0.007; cumulative morphine at 6 h, 5.6 ± 4.7 vs. 12.6 ± 7.5 mg, P <0.0001). Operative and postoperative (48 h) blood loss was modestly decreased in the treated group. Epidural-like distribution of anesthesia occurred in 3 of 28 plexus group patients, but no other side-effects were noted. Conclusions: Posterior lumbar plexus block provides effective analgesia for total hip arthroplasty, reducing intra- and postoperative opioid requirements. Moreover, blood loss during and after the procedure is diminished. Epidural anesthetic distribution should be anticipated in a minority of cases.

Original languageEnglish (US)
Pages (from-to)115-121
Number of pages7
JournalAnesthesiology
Volume93
Issue number1
StatePublished - Jul 2000
Externally publishedYes

Fingerprint

Lumbosacral Plexus
Arthroplasty
Hip
Pain
Morphine
Fentanyl
General Anesthesia
Anesthetics
Control Groups
Nerve Block
Bupivacaine
Pain Measurement
Postoperative Pain
Random Allocation
Visual Analog Scale
Peripheral Nerves
Analgesia
Opioid Analgesics
Epinephrine
Anesthesia

Keywords

  • Hip surgery
  • Regional anesthesia

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Stevens, R. D., Van Gessel, E., Flory, N., Foumier, R., & Gamulin, Z. (2000). Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. Anesthesiology, 93(1), 115-121.

Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. / Stevens, Robert David; Van Gessel, Elisabeth; Flory, Nicolas; Foumier, Roxane; Gamulin, Zdravko.

In: Anesthesiology, Vol. 93, No. 1, 07.2000, p. 115-121.

Research output: Contribution to journalArticle

Stevens, RD, Van Gessel, E, Flory, N, Foumier, R & Gamulin, Z 2000, 'Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty', Anesthesiology, vol. 93, no. 1, pp. 115-121.
Stevens RD, Van Gessel E, Flory N, Foumier R, Gamulin Z. Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. Anesthesiology. 2000 Jul;93(1):115-121.
Stevens, Robert David ; Van Gessel, Elisabeth ; Flory, Nicolas ; Foumier, Roxane ; Gamulin, Zdravko. / Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. In: Anesthesiology. 2000 ; Vol. 93, No. 1. pp. 115-121.
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abstract = "Background: The usefulness of peripheral nerve blockade in the anesthetic management of hip surgery has not been clearly established. Because sensory afferents from the hip include several branches of the lumbar plexus, the authors hypothesized that a lumbar plexus block could reduce pain from a major hip procedure. Methods: In a double-blind prospective trial, 60 patients undergoing total hip arthroplasty were randomized to receive general anesthesia with (plexus group, n = 30) or without (control group, n = 30) a posterior lumbar plexus block. The block was performed after induction using a nerve stimulator, and 0.4 ml/kg bupivacaine, 0.5{\%}, with epinephrine was injected. General anesthesia was standardized, and supplemental fentanyl was administered per hemodynamic guidelines. Postoperative pain and patient- controlled intravenous morphine use were serially assessed for 48 h. Results: The proportion of patients receiving supplemental fentanyl intraoperatively was more than 3 times greater in the control group (20 of 30 vs. 6 of 29, P = 0.001). In the postanesthesia care unit, a greater than fourfold reduction in pain scores was observed in the plexus group (visual analogue scale [VAS] pain score at arrival 1.3 ± 2 vs. 5.6 ± 3, P <0.001), and 'rescue' morphine boluses (administered if VAS > 3) were administered 10 times less frequently (in 2 of 28 vs. in 22 of 29 patients, P <0.0001). Pain scores and morphine consumption remained significantly lower in the plexus group until 6 h after randomization (VAS at 6 h, 1.4 ± 1.3 vs. 2.4 ± 1.4, P = 0.007; cumulative morphine at 6 h, 5.6 ± 4.7 vs. 12.6 ± 7.5 mg, P <0.0001). Operative and postoperative (48 h) blood loss was modestly decreased in the treated group. Epidural-like distribution of anesthesia occurred in 3 of 28 plexus group patients, but no other side-effects were noted. Conclusions: Posterior lumbar plexus block provides effective analgesia for total hip arthroplasty, reducing intra- and postoperative opioid requirements. Moreover, blood loss during and after the procedure is diminished. Epidural anesthetic distribution should be anticipated in a minority of cases.",
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N2 - Background: The usefulness of peripheral nerve blockade in the anesthetic management of hip surgery has not been clearly established. Because sensory afferents from the hip include several branches of the lumbar plexus, the authors hypothesized that a lumbar plexus block could reduce pain from a major hip procedure. Methods: In a double-blind prospective trial, 60 patients undergoing total hip arthroplasty were randomized to receive general anesthesia with (plexus group, n = 30) or without (control group, n = 30) a posterior lumbar plexus block. The block was performed after induction using a nerve stimulator, and 0.4 ml/kg bupivacaine, 0.5%, with epinephrine was injected. General anesthesia was standardized, and supplemental fentanyl was administered per hemodynamic guidelines. Postoperative pain and patient- controlled intravenous morphine use were serially assessed for 48 h. Results: The proportion of patients receiving supplemental fentanyl intraoperatively was more than 3 times greater in the control group (20 of 30 vs. 6 of 29, P = 0.001). In the postanesthesia care unit, a greater than fourfold reduction in pain scores was observed in the plexus group (visual analogue scale [VAS] pain score at arrival 1.3 ± 2 vs. 5.6 ± 3, P <0.001), and 'rescue' morphine boluses (administered if VAS > 3) were administered 10 times less frequently (in 2 of 28 vs. in 22 of 29 patients, P <0.0001). Pain scores and morphine consumption remained significantly lower in the plexus group until 6 h after randomization (VAS at 6 h, 1.4 ± 1.3 vs. 2.4 ± 1.4, P = 0.007; cumulative morphine at 6 h, 5.6 ± 4.7 vs. 12.6 ± 7.5 mg, P <0.0001). Operative and postoperative (48 h) blood loss was modestly decreased in the treated group. Epidural-like distribution of anesthesia occurred in 3 of 28 plexus group patients, but no other side-effects were noted. Conclusions: Posterior lumbar plexus block provides effective analgesia for total hip arthroplasty, reducing intra- and postoperative opioid requirements. Moreover, blood loss during and after the procedure is diminished. Epidural anesthetic distribution should be anticipated in a minority of cases.

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