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

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 proce...

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Bibliographic Details
Published in:Anesthesiology (Philadelphia) 2000-07, Vol.93 (1), p.115-121
Main Authors: STEVENS, R. D, VAN GESSEL, E, FLORY, N, FOURNIER, R, GAMULIN, Z
Format: Article
Language:English
Subjects:
Analgesia, Patient-Controlled
Analgesics, Opioid - therapeutic use
Anesthesia
Anesthesia depending on type of surgery
Anesthesia, General
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthetics, General
Arthroplasty, Replacement, Hip
Biological and medical sciences
Blood Pressure
Bupivacaine
Double-Blind Method
Female
Humans
Intraoperative Period
Lumbosacral Plexus
Male
Medical sciences
Middle Aged
Morphine - therapeutic use
Nerve Block
Orthopedic surgery. Maxillofacial surgery. Otorhinolaryngologic surgery. Stomatology. Ophtalmology. Investigation and treatment technics
Pain Measurement
Pain, Postoperative - prevention & control
Patient Satisfaction
Postoperative Hemorrhage - prevention & control
Prospective Studies
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Summary: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. 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. 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. 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.
ISSN:0003-3022
1528-1175
DOI:10.1097/00000542-200007000-00021