International Orthopaedics November 2017, Volume 41, Issue 11, pp 2229–2235

Comparison of analgaesia with lumbar epidurals and lumbar plexus nerve blocks in patients receiving multimodal analgaesics following primary total hip arthroplasty: a retrospective analysis

Harvey, N.R., Wolf, B.J., Bolin, E.D. et al.
Hip

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.


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