Health-Related Quality-of-Life After Hip Arthroplasty With and Without an Extended-Duration Continuous Posterior Lumbar Plexus Nerve Block: A Prospective, One-Year Follow-Up of a Randomized, Triple-Masked, Placebo-Controlled Study
Brian M. Ilfeld, MD, MS,1 Scott T. Ball, MD,2 Peter F. Gearen, MD,3 Edward R. Mariano, MD,4 Linda T. Le, MD,5 Krista Vandenborne, PhD, PT,6 Pamela W. Duncan, PhD, PT,7 Daniel I. Sessler, MD,8 F. Kayser Enneking, MD,9 Jonathan J. Shuster, PhD,10 Rosalita C. Maldonado, BS,11 and R. Scott Meyer, MD12Hip
Background
We previously reported that extending an overnight continuous posterior lumbar plexus nerve block to 4 days after hip arthroplasty provides clear benefits during the perineural infusion in the immediate postoperative period. However, it remains unknown if the extended infusion improves subsequent health-related quality-of-life.
Methods
Patients undergoing hip arthroplasty received a posterior lumbar plexus perineural infusion of ropivacaine 0.2% from surgery until the following morning, at which time patients were randomized to either continue perineural ropivacaine (n=24) or normal saline (n=23) in a double-masked fashion. Patients were discharged with their catheter and a portable infusion pump, and catheters were removed on postoperative day 4. Health-related quality-of-life was measured using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index preoperatively and then at 7 days, as well as 1, 2, 3, 6, and 12 months after surgery. The WOMAC evaluates 3 dimensions of health-related quality-of-life: pain, stiffness, and physical functional disability (global score of 0–96, lower scores indicate lower levels of symptoms or physical disability). For inclusion in the primary analysis, we required a minimum of 3 of the 6 time points, including day 7 and at least 2 of months 3, 6, and 12.
Results
The 2 treatment groups had similar global WOMAC scores for the mean area under the curve calculations (point estimate for the difference in mean area under the curve for the 2 groups [extended infusion group – overnight infusion group] = 0.8, 95% confidence interval: −5.3 to +6.8 [−5.5% to +7.1%]; p=0.80) and at all individual time points (p>0.05).
Conclusions
This investigation found no evidence that extending an overnight continuous posterior lumbar plexus nerve block to 4 days improves (or worsens) subsequent health-related quality-of-life between 7 days and 12 months after hip arthroplasty.
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