Is L2 Paravertebral Block Comparable to Lumbar Plexus Block for Postoperative Analgesia After Total Hip Arthroplasty?
Identifieur interne : 000243 ( France/Analysis ); précédent : 000242; suivant : 000244Is L2 Paravertebral Block Comparable to Lumbar Plexus Block for Postoperative Analgesia After Total Hip Arthroplasty?
Auteurs : Richa Wardhan [États-Unis] ; Anne-Sophie M. Auroux [États-Unis, France] ; Bruce Ben-David [États-Unis] ; Jacques E. Chelly [États-Unis]Source :
- Clinical Orthopaedics and Related Research [ 0009-921X ] ; 2014.
Descripteurs français
- KwdFr :
- Activité motrice, Adulte d'âge moyen, Analgésie autocontrôlée, Analgésiques morphiniques (usage thérapeutique), Arthroplastie prothétique de hanche (effets indésirables), Bloc nerveux (), Bloc nerveux (effets indésirables), Douleur postopératoire (), Douleur postopératoire (diagnostic), Douleur postopératoire (étiologie), Durée du séjour, Facteurs temps, Femelle, Humains, Mesure de la douleur, Morphine (usage thérapeutique), Mâle, Pennsylvanie, Plexus lombosacral, Rachianesthésie, Récupération fonctionnelle, Résultat thérapeutique, Sujet âgé.
- MESH :
- diagnostic : Douleur postopératoire.
- effets indésirables : Arthroplastie prothétique de hanche, Bloc nerveux.
- usage thérapeutique : Analgésiques morphiniques, Morphine.
- étiologie : Douleur postopératoire.
- Activité motrice, Adulte d'âge moyen, Analgésie autocontrôlée, Bloc nerveux, Douleur postopératoire, Durée du séjour, Facteurs temps, Femelle, Humains, Mesure de la douleur, Mâle, Pennsylvanie, Plexus lombosacral, Rachianesthésie, Récupération fonctionnelle, Résultat thérapeutique, Sujet âgé.
English descriptors
- KwdEn :
- Aged, Analgesia, Patient-Controlled, Analgesics, Opioid (therapeutic use), Anesthesia, Spinal, Arthroplasty, Replacement, Hip (adverse effects), Female, Humans, Length of Stay, Lumbosacral Plexus, Male, Middle Aged, Morphine (therapeutic use), Motor Activity, Nerve Block (adverse effects), Nerve Block (methods), Pain Measurement, Pain, Postoperative (diagnosis), Pain, Postoperative (etiology), Pain, Postoperative (prevention & control), Pennsylvania, Recovery of Function, Time Factors, Treatment Outcome.
- MESH :
- chemical , therapeutic use : Analgesics, Opioid, Morphine.
- geographic : Pennsylvania.
- adverse effects : Arthroplasty, Replacement, Hip, Nerve Block.
- diagnosis : Pain, Postoperative.
- etiology : Pain, Postoperative.
- methods : Nerve Block.
- prevention & control : Pain, Postoperative.
- Aged, Analgesia, Patient-Controlled, Anesthesia, Spinal, Female, Humans, Length of Stay, Lumbosacral Plexus, Male, Middle Aged, Motor Activity, Pain Measurement, Recovery of Function, Time Factors, Treatment Outcome.
Abstract
Continuous lumbar plexus block (LPB) is a well-accepted technique for regional analgesia after THA. However, many patients experience considerable quadriceps motor weakness with this technique, thus impairing their ability to achieve their physical therapy goals.
We asked whether L2 paravertebral block (PVB) provides better postoperative analgesia (defined as decreased postoperative opioid consumption and lower pain scores), better preservation of motor function, and decreased length of hospital stay (LOS) compared to LPB in patients undergoing THA.
Sixty patients undergoing minimally invasive THA under standardized spinal anesthesia were enrolled in this randomized controlled study. After exclusions, 53 patients were randomized into the L2 PVB (n = 27) and LPB (n = 26) groups. Patient-controlled analgesia was available for 24 hours. Motor and pain assessments were performed in the recovery room and at the end of 24 hours. LOS was also noted.
Postoperative opioid consumption during the first 24 hours was less in the LPB group (mean ± SD: 24 ± 15 mg morphine) than in the L2 PVB group (32 ± 15 mg morphine; p = 0.005); however, postoperative pain scores were not different between groups. Postoperative motor and rehabilitation outcomes and LOS were also similar.
Our study demonstrates that use of a LPB results in slightly less morphine consumption but comparable pain scores when compared with continuous L2 PVB. No difference was noted in terms of motor preservation or LOS. Although the difference in morphine consumption was only slightly in favor of the LPB group, the advantage of L2 PVBs noted by previous authors as preservation of motor function, was not seen. At our institute where LPBs have been performed for years, there seems to be no real advantage in switching to L2 PVBs. However, L2 PVB could be a reasonable alternative for operators who are wary of LPBs due to their high potential for complications and/or requiring advanced skills for its placement. But, since L2 PVBs are relatively new, not much is known about their complication profile. We recommend a thorough understanding of both techniques before attempting to place them.
Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Url:
DOI: 10.1007/s11999-013-3393-9
PubMed: 24390828
PubMed Central: 3971222
Affiliations:
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PMC:3971222Le document en format XML
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Auroux</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Department of Anesthesiology, University of Pittsburgh Medical Center, 532 S Aiken Avenue, Suite 407, Pittsburgh, PA 15232 USA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Anesthesiology, University of Pittsburgh Medical Center, 532 S Aiken Avenue, Suite 407, Pittsburgh</wicri:cityArea></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff3">Institut des Sciences Pharmaceutiques et Biologiques-Faculté de Pharmacie de Lyon Université, Lyon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Institut des Sciences Pharmaceutiques et Biologiques-Faculté de Pharmacie de Lyon Université, Lyon</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation></author><author><name sortKey="Ben David, Bruce" sort="Ben David, Bruce" uniqKey="Ben David B" first="Bruce" last="Ben-David">Bruce Ben-David</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Department of Anesthesiology, University of Pittsburgh Medical Center, 532 S Aiken Avenue, Suite 407, Pittsburgh, PA 15232 USA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Anesthesiology, University of Pittsburgh Medical Center, 532 S Aiken Avenue, Suite 407, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Chelly, Jacques E" sort="Chelly, Jacques E" uniqKey="Chelly J" first="Jacques E." last="Chelly">Jacques E. Chelly</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Department of Anesthesiology, University of Pittsburgh Medical Center, 532 S Aiken Avenue, Suite 407, Pittsburgh, PA 15232 USA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Anesthesiology, University of Pittsburgh Medical Center, 532 S Aiken Avenue, Suite 407, Pittsburgh</wicri:cityArea></affiliation></author></analytic><series><title level="j">Clinical Orthopaedics and Related Research</title><idno type="ISSN">0009-921X</idno><idno type="eISSN">1528-1132</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Analgesia, Patient-Controlled</term><term>Analgesics, Opioid (therapeutic use)</term><term>Anesthesia, Spinal</term><term>Arthroplasty, Replacement, Hip (adverse effects)</term><term>Female</term><term>Humans</term><term>Length of Stay</term><term>Lumbosacral Plexus</term><term>Male</term><term>Middle Aged</term><term>Morphine (therapeutic use)</term><term>Motor Activity</term><term>Nerve Block (adverse effects)</term><term>Nerve Block (methods)</term><term>Pain Measurement</term><term>Pain, Postoperative (diagnosis)</term><term>Pain, Postoperative (etiology)</term><term>Pain, Postoperative (prevention & control)</term><term>Pennsylvania</term><term>Recovery of Function</term><term>Time Factors</term><term>Treatment Outcome</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Activité motrice</term><term>Adulte d'âge moyen</term><term>Analgésie autocontrôlée</term><term>Analgésiques morphiniques (usage thérapeutique)</term><term>Arthroplastie prothétique de hanche (effets indésirables)</term><term>Bloc nerveux ()</term><term>Bloc nerveux (effets indésirables)</term><term>Douleur postopératoire ()</term><term>Douleur postopératoire (diagnostic)</term><term>Douleur postopératoire (étiologie)</term><term>Durée du séjour</term><term>Facteurs temps</term><term>Femelle</term><term>Humains</term><term>Mesure de la douleur</term><term>Morphine (usage thérapeutique)</term><term>Mâle</term><term>Pennsylvanie</term><term>Plexus lombosacral</term><term>Rachianesthésie</term><term>Récupération fonctionnelle</term><term>Résultat thérapeutique</term><term>Sujet âgé</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Analgesics, Opioid</term><term>Morphine</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Pennsylvania</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Arthroplasty, Replacement, Hip</term><term>Nerve Block</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Pain, Postoperative</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Douleur postopératoire</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Arthroplastie prothétique de hanche</term><term>Bloc nerveux</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Pain, Postoperative</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Nerve Block</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Pain, Postoperative</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Analgésiques morphiniques</term><term>Morphine</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Douleur postopératoire</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Analgesia, Patient-Controlled</term><term>Anesthesia, Spinal</term><term>Female</term><term>Humans</term><term>Length of Stay</term><term>Lumbosacral Plexus</term><term>Male</term><term>Middle Aged</term><term>Motor Activity</term><term>Pain Measurement</term><term>Recovery of Function</term><term>Time Factors</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Activité motrice</term><term>Adulte d'âge moyen</term><term>Analgésie autocontrôlée</term><term>Bloc nerveux</term><term>Douleur postopératoire</term><term>Durée du séjour</term><term>Facteurs temps</term><term>Femelle</term><term>Humains</term><term>Mesure de la douleur</term><term>Mâle</term><term>Pennsylvanie</term><term>Plexus lombosacral</term><term>Rachianesthésie</term><term>Récupération fonctionnelle</term><term>Résultat thérapeutique</term><term>Sujet âgé</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Continuous lumbar plexus block (LPB) is a well-accepted technique for regional analgesia after THA. However, many patients experience considerable quadriceps motor weakness with this technique, thus impairing their ability to achieve their physical therapy goals.</p></sec><sec><title>Questions/purposes</title><p>We asked whether L2 paravertebral block (PVB) provides better postoperative analgesia (defined as decreased postoperative opioid consumption and lower pain scores), better preservation of motor function, and decreased length of hospital stay (LOS) compared to LPB in patients undergoing THA.</p></sec><sec><title>Methods</title><p>Sixty patients undergoing minimally invasive THA under standardized spinal anesthesia were enrolled in this randomized controlled study. After exclusions, 53 patients were randomized into the L2 PVB (n = 27) and LPB (n = 26) groups. Patient-controlled analgesia was available for 24 hours. Motor and pain assessments were performed in the recovery room and at the end of 24 hours. LOS was also noted.</p></sec><sec><title>Results</title><p>Postoperative opioid consumption during the first 24 hours was less in the LPB group (mean ± SD: 24 ± 15 mg morphine) than in the L2 PVB group (32 ± 15 mg morphine; p = 0.005); however, postoperative pain scores were not different between groups. Postoperative motor and rehabilitation outcomes and LOS were also similar.</p></sec><sec><title>Conclusions</title><p>Our study demonstrates that use of a LPB results in slightly less morphine consumption but comparable pain scores when compared with continuous L2 PVB. No difference was noted in terms of motor preservation or LOS. Although the difference in morphine consumption was only slightly in favor of the LPB group, the advantage of L2 PVBs noted by previous authors as preservation of motor function, was not seen. At our institute where LPBs have been performed for years, there seems to be no real advantage in switching to L2 PVBs. However, L2 PVB could be a reasonable alternative for operators who are wary of LPBs due to their high potential for complications and/or requiring advanced skills for its placement. But, since L2 PVBs are relatively new, not much is known about their complication profile. We recommend a thorough understanding of both techniques before attempting to place them.</p></sec><sec><title>Level of Evidence</title><p>Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.</p></sec></div></front></TEI><affiliations><list><country><li>France</li><li>États-Unis</li></country><region><li>Auvergne-Rhône-Alpes</li><li>Connecticut</li><li>Pennsylvanie</li><li>Rhône-Alpes</li></region><settlement><li>Lyon</li></settlement></list><tree><country name="États-Unis"><region name="Pennsylvanie"><name sortKey="Wardhan, Richa" sort="Wardhan, Richa" uniqKey="Wardhan R" first="Richa" last="Wardhan">Richa Wardhan</name></region><name sortKey="Auroux, Anne Sophie M" sort="Auroux, Anne Sophie M" uniqKey="Auroux A" first="Anne-Sophie M." last="Auroux">Anne-Sophie M. Auroux</name><name sortKey="Ben David, Bruce" sort="Ben David, Bruce" uniqKey="Ben David B" first="Bruce" last="Ben-David">Bruce Ben-David</name><name sortKey="Chelly, Jacques E" sort="Chelly, Jacques E" uniqKey="Chelly J" first="Jacques E." last="Chelly">Jacques E. Chelly</name><name sortKey="Wardhan, Richa" sort="Wardhan, Richa" uniqKey="Wardhan R" first="Richa" last="Wardhan">Richa Wardhan</name></country><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Auroux, Anne Sophie M" sort="Auroux, Anne Sophie M" uniqKey="Auroux A" first="Anne-Sophie M." last="Auroux">Anne-Sophie M. Auroux</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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