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

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)

Continuous Lumbar Plexus Block under the Guidance of the “Shamrock Method” Ultrasound: Analgesic Effects and Hemodynamic Effects after Total Knee Arthroplasty in Elderly Patients

Objective. To explore the effect of continuous lumbar plexus block guided by the “Shamrock method” on postoperative analgesia and hemodynamics in elderly patients after total knee arthroplasty (TKA). Methods. From January 2020 to December 2020 in our hospital, 98 patients who underwent TKA were selected. Using the random number table method, the patients were divided into two groups: a continuous lumbar plexus block group (group L), with 49 patients, and a continuous femoral nerve block group (group F), with 49 patients. The onset time and maintenance time of motor and sensory nerve blocks in patients were recorded. A visual analogue scale (VAS) was applied to assess the pain severity at 6, 12, 24, and 48 h after the operation. The VAS score (FVAS) was applied to evaluate the pain severity of the patients during 24 and 48 h after the operation and knee joint functional exercise. The levels of hemodynamic indexes such as heart rate, mean arterial pressure, and oxyhemoglobin saturation and the levels of hemorheological indexes such as plasma viscosity, high and low whole blood shear viscosity, fibrinogen, and hematocrit were detected and compared between the two groups immediately after the operation and at 12 h and 48 h after the operation, respectively. The incidence of adverse reactions induced by anesthesia was counted. Results. The onset time of motor and sensory nerve blocks in group L was lower than that in group F, and the maintenance time was higher than that in group F ( P < 0.05 ). The VAS scores of 6, 12, 24, and 48 h after operation in group L were significantly lower than those in group F ( P < 0.05 ). The FVAS scores of group L at 24 and 48 h after operation were significantly lower than those of group F ( P < 0.05 ). The heart rates of the patients in the two groups were higher at 12 h and 48 h after operation than those immediately after operation ( P < 0.05 ). The heart rates at 12 h and 48 h after operation in group L were lower than those in group F ( P < 0.05 ). The plasma viscosity, high whole blood shear viscosity, and low whole blood shear viscosity in the group L at 12 h and 48 h after operation were lower than those in group F ( P < 0.05 ). There was no significant difference in the incidence of local anesthetic poisoning, nausea, vomiting, urinary retention, pruritus, and other adverse reactions between the two groups ( P > 0.05 ). Conclusion. The “Shamrock method” ultrasound-guided continuous lumbar plexus block in elderly patients after TKA has good analgesic effect, stable hemodynamics, little influence on hemorheology, and good safety. It is of great value to enhance the surgical effect and promote postoperative rehabilitation.

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

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.

Sciatic Nerve and Lumbar Plexus Block for Below Knee Amputation- Newer Approach for Better Haemodynamic Stability and Patient Safety

Patients undergoing lower extremity amputation may have multiple co-morbid conditions like diabetes, cardiovascular, hepatic and renal disorders and are at risk of perioperative mortality and morbidity. Peripheral nerve blocks are associated with minimal haemodynamic changes, improved regional blood flow and are ideal for high risk patients who cannot tolerate slightest attenuation in haemodynamic response. The present report is of a 50-year-old female patient admitted for below knee amputation surgery. Sciatic nerve and lumbar plexus block were the mode of anaesthesia. It was found that regional anaesthesia in the form of nerve block provided adequate anaesthesia and analgesia, provided greater haemodynamic stability and patient safety.