scholarly journals A comparative study of buprenorphine in two different doses as an adjuvant to levobupivacaine in US-guided lumbar plexus block for postoperative analgesia

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Vaibhav Tulsyan ◽  
Jai Singh ◽  
Lokesh Thakur ◽  
Versha Verma ◽  
Ashish Minhas
Keyword(s):  
Postoperative Analgesia ◽  
Lumbar Plexus ◽  
Control Group ◽  
Sensory Level ◽  
Pain Scores ◽  
Total Pain ◽  
Lumbar Plexus Block ◽  
Number Of Patients ◽  
Plexus Block ◽  
Different Doses

Abstract Background Lumbar plexus block (LPB) is a proven modality to provide analgesia following lower limb surgeries. The present study compared the effect of buprenorphine in different doses viz. 150 μg and 300 μg as an adjuvant to levobupivacaine in unilateral lumbar plexus block. In this prospective, controlled, and double-blind study, ninety patients undergoing hip, thigh, and knee surgeries under subarachnoid block were enrolled. The patients were randomly allocated into three groups of thirty each, to receive LPB with 0.25% levobupivacaine plain (group L), 0.25% levobupivacaine with 150 μg buprenorphine (group BL), or 0.25% levobupivacaine with 300 μg buprenorphine (group BH), after the sensory level of subarachnoid receded to T10. Total volume administered was 30 ml. The duration of analgesia post LPB, total pain-free period, cumulative rescue analgesic doses per patient, number of patients requiring rescue analgesic, pain scores using visual analog scale (VAS), and sedation levels were noted at protocolized predetermined intervals in each case. Results The duration of analgesia post LPB was significantly prolonged in both the buprenorphine groups (9.76 ± 1.39 h in group with 150 μg buprenorphine and 10.13 ± 1.5 h in group with 300 μg buprenorphine) as compared to 4.25 ± 0.93 h in the control group (p < 0.001). The total pain free-period of 12.81 ± 1.49 h was maximum in group BH as compared to 12.42 ± 1.47 h in group BL and 7.01 ± 0.89 h in group L and was statistically significant with the control group (p = 0.001). The cumulative rescue analgesic doses per patient was also significantly higher in control group L (3.10 ± 0.40) as compared to groups BL (1.77 ± 0.5) and BH (1.33 ± 0.48). There was significant decrease in pain scores in patients of both buprenorphine groups compared to the control group up to 24 h (p < 0.001). In group BH, patients were sedated in the first hour with a modified Ramsay Sedation Score of 1.93 ± 0.86 which was statistically significant from the group L (modified RSS of 1.00 ± 0.00, p = 0.003) as well as from group BL (modified RSS of 1.47 ± 0.50, p = 0.043). Conclusions Buprenorphine in either of the doses (150 μg or 300 μg) as an adjuvant to levobupivacaine in lumbar plexus block provided comparable postoperative analgesia. A dose of 300 μg, however, resulted in significant sedation and respiratory depression. Hence, buprenorphine 150 μg appears to be an optimal dose providing prolonged postoperative analgesia and minimal sedation.

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 &lt; 0.001), and "rescue" morphine boluses (administered if VAS &gt; 3) were administered 10 times less frequently (in 2 of 28 vs. in 22 of 29 patients, P &lt; 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 &lt; 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.

scholarly journals Analgesic efficacy and safety of four different anesthesia/postoperative analgesia protocols in patients following total hip arthroplasty

2017 ◽  
Vol 74 (9) ◽  
pp. 814-820 ◽  
Author(s):  
Mirjana Kendrisic ◽  
Maja Surbatovic ◽  
Dragan Djordjevic ◽  
Bratislav Trifunovic ◽  
Jasna Jevdjic
Keyword(s):  
Side Effects ◽  
Total Hip Arthroplasty ◽  
Epidural Analgesia ◽  
Hip Arthroplasty ◽  
Postoperative Analgesia ◽  
Lumbar Plexus ◽  
Pain Scores ◽  
Lumbar Plexus Block ◽  
Plexus Block ◽  
Satisfactory Analgesia

Background/Aim. Hip replacement surgery can initiate significant postoperative pain caused by bone alterations, implant, and soft tissue or nerve injuries. Postoperative analgesia using regional techniques has been shown to have numerous advantages over the intravenous use of morphine. However, numerous side effects and complications of postoperative continuous epidural analgesia have been reported recently. The aim of this prospective, randomized study was to investigate whether continuous lumbar plexus block can be a safe and efficacious alternative for postoperative analgesia in comparison with epidural analgesia and patient-controlled analgesia with morphine (PCA morphine) for hip arthroplasty. Methods. This prospective study included 60 patients, scheduled for total hip arthroplasty. Patients were randomized into 4 groups: the group central nerve block ? epidural (CNB), the group peripheral nerve block ? lumbar plexus block (PNB), the group spinal anesthesia-PCA morphine (SAM) and the group general anesthesia-PCA morphine (GAM). The quality of analgesia and side effects (hypotension, nausea, vomiting, urinary retention) were recorded in all groups at 4 h, 12 h, and 24 h after surgery. Pain scores were assessed using Visual Analogue Scale (VAS), both at rest and on moving. Results. Our findings demonstrated that the use of a continuous lumbar plexus block provides effective analgesia at rest and on moving, during 24 h after hip arthroplasty. Pain scores varied significantly among the groups 4 h postoperatively (F = 21.827; p < 0.01), 12 h postoperatively (F = 41.925; p < 0.01) and 24 h postoperatively (F = 33.768; p < 0.01) with the highest scores ? 3 in the GAM group. Patients from the PNB group had satisfactory analgesia, comparable with patients from the CNB group. The incidence of nausea was significantly lower in the PNB group 12 h after the operation (?2 = 9.712; p < 0.01). The incidence of urine retention was significantly different 12 h after the operation, with a presence only in the CNB group, with the incidence of 33.3% (?2 = 16.365; p < 0.01). In all studied groups, the incidence of hypotension was not significantly different postoperatively. Conclusion. Administration of postoperative analgesia using continuous lumbar plexus block produces satisfactory analgesia with a low incidence of side effects when compared to epidural analgesia or parenteral opioids following hip arthroplasty.

scholarly journals Lumbar plexus block as a method of postoperative analgesia after hip surgery

2011 ◽  
Vol 27 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Sherif Anis ◽  
Nabil Abd El Moaty ◽  
Azza Youssef ◽  
Raouf Ramzy ◽  
Raham Hassan
Keyword(s):  
Postoperative Analgesia ◽  
Lumbar Plexus ◽  
Hip Surgery ◽  
Lumbar Plexus Block ◽  
Plexus Block

scholarly journals Postoperative analgesia for hip arthroplasty: comparison of continuous lumbar plexus block and epidural analgesia

Revista Dor ◽  
2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Gabriela Maria Pereira da Silva e Costa ◽  
Inês Martins Carvalho ◽  
Ana Isabel Rodrigues Castro ◽  
Neusa Cristina Ribeiro Lages ◽  
Carlos Manuel Machado Correia
Keyword(s):  
Epidural Analgesia ◽  
Hip Arthroplasty ◽  
Postoperative Analgesia ◽  
Lumbar Plexus ◽  
Lumbar Plexus Block ◽  
Plexus Block

scholarly journals Comparative Study between Spinal Anesthesia and Lumbar Plexus Block for Intraoperative Anesthesia and Postoperative Analgesia in Fracture Femur Surgery

2020 ◽  
pp. 75-84
Author(s):  
Mohamed G. Naeem ◽  
Naglaa K. Mohammed ◽  
Reda S. Abd Elrahman ◽  
Osama M. Shalaby
Keyword(s):  
Spinal Anesthesia ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Lumbar Plexus ◽  
Controlled Study ◽  
Anesthetic Technique ◽  
Fracture Femur ◽  
Group I ◽  
Lumbar Plexus Block ◽  
Plexus Block

Background: Fracture femur is common in elderly. Spinal anesthesia (SA) in elderly patients can be associated with major hemodynamic changes whereas lumbar plexus block (LPB) can provide ideal perioperative analgesia as there is no hemodynamic instability or depression of pulmonary functions. The purpose of this study is to compare the efficacy of SA versus LPB for intraoperative anesthesia and postoperative analgesia in fracture femur surgery. Materials and Methods: This prospective randomized controlled study was carried out 70 patients of either sex with age >20 years, ASA physical status I - III scheduled for fracture femur surgery. Patients were randomly classified into two equal groups (n = 35); group I (SA) received SA by heavy bupivacaine HCL 0.5% 2.5-3.5 ml and group II (LBP) received posterior LPB by 30-35 ml bupivacaine 0.5%. Results: The time for performing the block was significantly longer in group LPB than group SA. The onset of sensory and motor block was significantly increased in group LPB than group SA. The intraoperative HR was significantly increased, and intraoperative MAP was significantly decreased in group SA compared to group LPB at 5, 10, 15, 20, 25 and 30 minutes. Postoperative HR and MAP was significantly increased in group SA compared to group LPB at 1 and 6 h. Postoperative VAS was significantly increased in group SA than group LPB at 1 and 6 h. The duration of sensory and motor block was significantly increased in group LPB than group SA. The time of postoperative first analgesic requirement was significantly longer and the total pethidine consumption in the 1st 24 h was significantly lower in group LPB than group SA. SA was associated with significant increase in hypotension, nausea, vomiting and headache. Conclusion: LPB is an effective alternative to SA as an anesthetic technique for femur fracture surgeries. LBP offers a more stable intraoperative hemodynamics and provides longer duration of analgesia postoperatively with less side effects. However, SA has shorter time for performing the block with earlier onset of sensory and motor block.

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