Harvey N Robert, Wolf Bethany J, Bolin Eric D, Wilson Sylvia H
Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, MSC 912, Charleston, SC, 29425, USA.
Department of Public Health Sciences, Medical University of South Carolina, 302B 135 Cannon St., Charleston, SC, 29425-9120, USA.
Int Orthop. 2017 Nov;41(11):2229-2235. doi: 10.1007/s00264-017-3465-7. Epub 2017 Apr 11.
Significant post-operative pain occurs after hip arthroplasty. In a prior study, lumbar plexus nerve blocks provided comparable analgaesia to lumbar epidurals; however, multimodal analgaesics were not used consistently.
This study assessed a randomly selected cohort of 48 patients undergoing primary hip arthroplasty who received a regional anaesthesia technique for post-operative pain. Twenty-four patients with lumbar epidurals and 24 with single-injection lumbar plexus nerve blocks were reviewed using electronic medical records. Post-operative opiate consumption was the primary endpoint. Secondary endpoints were participation in physical therapy, side effects, and time to discharge. Descriptive statistics were calculated to describe patients in the different groups. Opiate consumption was compared using linear mixed models. Multivariable models were examined for both primary and secondary endpoints.
In comparison with patients receiving lumbar epidural catheters, patients with lumbar plexus blocks consumed less opiates post-operatively at 24-36 and 36-48 hours (P = 0.037 and 0.002, respectively); it did not differ at zero to 12 hours or 12-24 hours post-operatively. Patients with lumbar plexus blocks had earlier times to first ambulation (28.5 ± 3.29 vs 21.9 ± 1.76 h; P = 0.043). However, differences by block type were not observed for ambulation distance, level of assistance to ambulate or time of discharge orders.
Following primary total hip arthroplasty, lumbar plexus nerve blocks provide effective post-operative analgaesia with decreased opiate consumption compared with lumbar epidural catheters. Lumbar plexus blocks also promote earlier post-operative ambulation and are compatible with post-operative prophylactic anticoagulants.
髋关节置换术后会出现明显的术后疼痛。在先前的一项研究中，腰丛神经阻滞提供的镇痛效果与腰段硬膜外阻滞相当；然而，多模式镇痛药的使用并不一致。
本研究评估了随机选取的48例接受初次髋关节置换术并采用区域麻醉技术进行术后镇痛的患者。通过电子病历回顾了24例接受腰段硬膜外阻滞和24例接受单次注射腰丛神经阻滞的患者。术后阿片类药物的消耗量是主要终点。次要终点包括参与物理治疗的情况、副作用以及出院时间。计算描述性统计数据以描述不同组的患者。使用线性混合模型比较阿片类药物的消耗量。对主要和次要终点均进行多变量模型检验。
与接受腰段硬膜外导管置入的患者相比，接受腰丛神经阻滞的患者在术后24 - 36小时和36 - 48小时阿片类药物消耗量更少（分别为P = 0.037和0.002）；术后0至12小时或12 - 24小时无差异。接受腰丛神经阻滞的患者首次下床活动时间更早（28.5 ± 3.29小时 vs 21.9 ± 1.76小时；P = 0.043）。然而，在行走距离、行走辅助水平或出院医嘱时间方面未观察到阻滞类型的差异。
初次全髋关节置换术后，与腰段硬膜外导管相比，腰丛神经阻滞提供有效的术后镇痛，且阿片类药物消耗量减少。腰丛神经阻滞还能促进术后更早下床活动，并且与术后预防性抗凝剂相容。
