scholarly journals Pre-operative lumbar plexus block provides superior post-operative analgesia when compared with fascia iliaca block or general anesthesia alone in hip arthroscopy

2016 ◽  
pp. hnw021 ◽  
Author(s):  
Andrew B. Wolff ◽  
Geoffrey W. Hogan ◽  
James M. Capon ◽  
Alexandra M. Napoli ◽  
Hayden J. Smith ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Hip Arthroscopy ◽  
Lumbar Plexus ◽  
Lumbar Plexus Block ◽  
Fascia Iliaca Block ◽  
Plexus Block

scholarly journals Pre-operative Lumbar Plexus Block Provides Superior Post-operative Analgesia when Compared with Fascia Iliaca Block or General Anesthesia Alone in Hip Arthroscopy

2016 ◽  
Vol 4 (3_suppl3) ◽  
pp. 2325967116S0006 ◽  
Author(s):  
Andrew B. Wolff ◽  
Geoffrey W. Hogan ◽  
James Capon ◽  
Hayden Smith ◽  
Alexandra M. Napoli ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Hip Arthroscopy ◽  
Lumbar Plexus ◽  
Lumbar Plexus Block ◽  
Fascia Iliaca Block ◽  
Plexus Block

Pain Management After Hip Arthroscopy: Systematic Review of Randomized Controlled Trials and Cohort Studies

2017 ◽  
Vol 46 (13) ◽  
pp. 3288-3298 ◽  
Author(s):  
Jason J. Shin ◽  
Chris L. McCrum ◽  
Craig S. Mauro ◽  
Dharmesh Vyas
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Postoperative Pain ◽  
Hip Arthroscopy ◽  
Pain Control ◽  
Femoral Nerve ◽  
Lumbar Plexus ◽  
Nerve Blocks ◽  
Fascia Iliaca Block ◽  
Plexus Block

Background: Hip arthroscopy is often associated with significant postoperative pain and opioid-associated side effects. Effective pain management after hip arthroscopy improves patient recovery and satisfaction and decreases opioid-related complications. Purpose: To collect, examine, and provide a comprehensive review of the available evidence from randomized controlled trials and comparative studies on pain control after hip arthroscopy. Study Design: Systematic review. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature for postoperative pain control after hip arthroscopy was performed using electronic databases. Only comparative clinical studies with level 1 to 3 evidence comparing a method of postoperative pain control with other modalities or placebo were included in this review. Case series and studies without a comparative cohort were excluded. Results: Several methods of pain management have been described for hip arthroscopy. A total of 14 studies met our inclusion criteria: 3 on femoral nerve block, 3 on lumbar plexus block, 3 on fascia iliaca block, 4 on intra-articular injections, 2 on soft tissue surrounding surgical site injection, and 2 on celecoxib (4 studies compared 2 or more methods of analgesia). The heterogeneity of the studies did not allow for pooling of data. Single-injection femoral nerve blocks and lumbar plexus blocks provided improved analgesia, but increased fall rates were observed. Fascia iliaca blocks do not provide adequate pain relief when compared with surgical site infiltration with local anesthetic and are associated with increased risk of cutaneous nerve deficits. Patients receiving lumbar plexus block experienced significantly decreased pain compared with fascia iliaca block. Portal site and periacetabular injections provide superior analgesia compared with intra-articular injections alone. Preoperative oral celecoxib, compared with placebo, resulted in earlier time to discharge and provided significant pain relief up to 24 hours. Conclusion: Perioperative nerve blocks provide effective pain management after hip arthroscopy but must be used with caution to decrease risk of falls. Intra-articular and portal site injections with local anesthetics and preoperative celecoxib can decrease opioid consumption. There is a lack of high-quality evidence on this topic, and further research is needed to determine the best approach to manage postoperative pain and optimize patient satisfaction.

Lumbar Plexus Block Reduces Pain and Blood Loss Associated with Total Hip Arthroplasty

2000 ◽  
Vol 93 (1) ◽  
pp. 115-121 ◽  
Author(s):  
Robert D. Stevens ◽  
Elisabeth Van Gessel ◽  
Nicolas Flory ◽  
Roxane Fournier ◽  
Zdravko Gamulin
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
General Anesthesia ◽  
Hip Arthroplasty ◽  
Lumbar Plexus ◽  
Control Group ◽  
Total Hip ◽  
Pain Scores ◽  
Lumbar Plexus Block ◽  
Plexus Block

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.

Lumbar plexus block versus suprainguinal fascia iliaca block for total hip arthroplasty: A single-blinded, randomized trial

2020 ◽  
Vol 66 ◽  
pp. 109907 ◽  
Author(s):  
Daniela Bravo ◽  
Sebastián Layera ◽  
Julián Aliste ◽  
Álvaro Jara ◽  
Diego Fernández ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Randomized Trial ◽  
Hip Arthroplasty ◽  
Lumbar Plexus ◽  
Total Hip ◽  
Lumbar Plexus Block ◽  
Fascia Iliaca Block ◽  
Plexus Block

scholarly journals Ultrasound-Guided Lumbar Plexus Block Reduces Emergence Agitation in Children Undergoing Hip Surgery: A Prospective Randomized Controlled Trial

2022 ◽  
Author(s):  
Hui Zhang ◽  
Junfeng Zhang ◽  
Xiaofeng Wang ◽  
Tao Xu ◽  
Hai Yan ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Lumbar Plexus ◽  
Hip Surgery ◽  
Emergence Agitation ◽  
Ultrasound Guided ◽  
General Anesthesia Group ◽  
Anesthesia Group ◽  
Lumbar Plexus Block ◽  
Group Control ◽  
Plexus Block

Abstract Background Emergence agitation (EA) is a common and challenging postoperative problem in children emerging from general anesthesia. It is associated with self-injury, increases stress on healthcare team members and postoperative maladaptive behavioral changes. However, no completely effective prevention has been found for EA. Pain is considered to be an important contributor to EA. Ultrasound-guided lumbar plexus block is a safe and effective anesthetic technique that can provide satisfactory pain relief in pediatric hip surgery. We aim to investigate the effect of ultrasound-guided lumbar plexus block on emergence agitation in children undergoing hip surgery. Methods This prospective, randomized, controlled study was conducted in children aged 1-6 yr undergoing elective hip surgery. Subjects were randomly assigned to receive either ultrasound-guided lumbar plexus block combined with general anesthesia (Group Block, n=60) or routine general anesthesia (Group Control, n=60). The primary outcome was the incidence of EA at 30 min after emergence from general anesthesia, assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale. The secondary outcomes included the incidence of severe EA, postoperative pain evaluated by the Children’s Hospital of eastern Ontario Pain Scale (CHEOPS) and the incidence of postoperative adverse complications. PAED, CHEOPS were measured at 0, 5, 10, 20, and 30 min after emergence from anesthesia. Results The incidence of EA was significantly lower in Group Block than in Group Control [13.3% vs. 43.3%, odds ratio (OR) 0.201, 95% confidence interval (CI) 0.082to 0.496, p<0.001]. Group Block had a lower incidence of severe EA than Group Control [3.3% vs. 18.3%, odds ratio (OR) 0.154, 95% confidence interval (CI) 0.032 to 0.727, p=0.019]. CHEOPS was lower in Group Block than in Group Control [mean (95%CI), 4.5(4.4-4.6) vs.4.9 (4.8-5.0), p<0.001]. Conclusion Ultrasound-guided lumbar plexus block could decrease the incidence and severity of emergence agitation in children undergoing hip surgery effectively. Trial registration: Chinese Clinical Trial Registry: ChiCTR-INR-17011525 (30/05/2017)

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