Postoperative pain management after hip replacement: efficiency comparison of epidural analgesia and continuous lumbar plexus block

Abstract

Aims: Comparison of epidural analgesia and continuous lumbar plexus block for postoperative pain management after hip replacement. Evaluation of pain control efficacy, need of additional analgesics, degree of motor block and side-effects. Methods: After receiving the approval from the local human ethics committee, the prospective, randomized, double-blind study was conducted. 34 ASA I or II class patients who underwent primary hip replacement surgery were enrolled. Spinal block was used for anesthesia. Patients were randomized into two groups: epidural analgesia (EA) and lumbar plexus block (LPB). Patients of EA group received a continuous lumbar epidural infusion of Bupivacaine 0.125% and Fentanyl 0.05 mg/ml mixture at a rate of 3-5 ml/h. In the LPB group the lumbar plexus catheter was placed using posterior approach and patients received the same mixture of drugs at a rate of 5-10 ml/h. We evaluated these parameters on the surgery day (min. 6 hours after the operation) and on the 1st and 2nd day after the surgery: pain intensity (visual analog scale, 0-10 points), degree of motor block (Bromage scale, 0-3 points), need of additional analgetics, side-effects (nausea, vomiting and itch). Results: There was no significant difference in patient demographics. The postoperative pain management was equally efficient in both groups, but additional analgesics were required more commonly in epidural analgesia group (29.4% vs. 5.9%). There were significantly more patients with complete motor block in LPB group (64.7% vs. 17.6%). The frequency of side-effects in both groups did not differ significantly. Conclusions: 1. The postoperative pain management was equally efficient in both groups, but additional analgesics were required more commonly in epidural analgesia group. 2. Degree of motor block was significantly higher in the lumbar plexus block group. 3. Continuous lumbar plexus block for postoperative [...].