Comparison of the epidural block and posterior lumbar plexus block for intra- and postoperative analgesia in total hip arthroplasty

Abstract

Objectives. Evaluation of management of intra- and postoperative analgesia in patients who benefited from total hip arthroplasty in the surgical treatment of coxarthrosis. The achievement of this goal could reside in the comparison of two distinct methods of anaesthesiology: epidural analgesia and continuous lumbar plexus block. Materials and methods. The current prospective study, conducted between January 2014 and January 2016, targets a total of 48 patients who underwent total hip replacement surgery. There was a split in two groups: 23 patients benefited from epidural analgesia and 25 patients were selected for lumbar plexus block, depending on the procedure chosen by the anaesthetist. Both groups received the same concentration of initial dose of 0.75% Ropivacaine, the first group initially receiving 3 ml (test dose), then another 6 ml, and the second initially 5 ml (test dose), then 15 ml. Through catheters were injected continuously 8 ml / h of 0.2% Ropivacaine for the first group and 10 ml / h of Ropivacaine 0.375%, these doses being adjusted to Pain Visits, performed twice a day. The purpose of these visits was to monitor both the evolution of implanted catheters and the completion of mandatory protocols (these protocols monitor sensitivity and motor activity of limbs, initiation of mobilization, opioid supplementation to ongoing therapy, and patients' satisfaction with therapy, at catheter removal). Results. Patients in the first group had the highest satisfaction rate of 30.4%, compared to patients in the second group, who scored 52% for the 15 (maximum) level of satisfaction. In the first group of patients, 52.2% did not require additional opioids for ongoing therapy (in postoperative units or in the department), while for patients in the second group the percentage was 60%. In terms of complications, the differences are notable and have an important statistical value: the first category of patients, 52.17% (n = 12), the second category, 12% (n = 3). Day zero (surgery day) is not marked by significant differences between the two categories of people in treatment, in terms of pain intensity. At rest, 78.2% of the first category patients and 84% of the second category patients had a NRS of less than or equal to 4, while in the state of mobilization, the percent ages were 78.2% and 80% respectively. The initiation of mobilization is an important parameter, which also presents variations between the two groups of patients: 73.9% of them initiated the mobilization on the first postoperative day (group I) and 88% initiated the mobilization on the first postoperative day (group II). Conclusions. Both methods of regional anaesthesia determine optimal analgesia for patients operated by THA with an onset of ideal mobilization from the first postoperative day, but the continuous lumbar plexus block produces better mobility in the second postoperative day and has a lower complications rate.

Keywords

• continuous lumbar plexus block
• epidural analgesia
• psoas muscles
• total hip arthroplasty