| Continuous lumbar plexus block provides improved analgesia with fewer side effects compared with systemic opioids after hip arthroplasty: a randomized controlled trial. | |
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MedLine Citation:
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PMID: 17961837 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND OBJECTIVES: A single injection lumbar plexus block for acute pain management after hip surgery is usually limited to the immediate postoperative period. We conducted a randomized controlled trial to determine the effect of a continuous lumbar plexus block on perioperative opioid requirements and pain intensity. METHODS: Adult patients undergoing elective hip arthroplasty under general anesthesia were randomized to continuous lumbar plexus block combined with patient-controlled analgesia (PCA) or PCA only for postoperative pain. Patients allocated to the lumbar plexus block had the catheter placed before surgery. Patients were followed for 36 hours. Perioperative opioid requirement was the primary outcome; secondary outcomes included assessment of pain intensity, patient and surgeon satisfaction with the analgesic technique, and occurrence of nausea and vomiting. RESULTS: Seventeen patients were randomized to each treatment group. Compared with patients in the PCA group, patients in the continuous lumbar plexus block group required less morphine (12 mg) (95% CI, -12.9 to -3.9), had on average less pain (-2.1 units on a 0 to 10 scale) (95% CI, -3.8 to -1.1), were more satisfied with their analgesic technique, and experienced less nausea and vomiting. One patient in the continuous lumbar plexus block developed a delayed paresis and 1 patient in the PCA group developed respiratory depression. CONCLUSIONS: Continuous lumbar plexus block combined with PCA is superior to PCA alone for postoperative pain management following hip replacement. It reduces opioid requirements, opioid related side effects, and enhances patient satisfaction. However, additional research is required to determine its safety in light of the neurologic injury observed. |
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Authors:
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Zafar I Siddiqui; M Soledad Cepeda; William Denman; Roman Schumann; Daniel B Carr |
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Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Regional anesthesia and pain medicine Volume: 32 ISSN: 1098-7339 ISO Abbreviation: Reg Anesth Pain Med Publication Date: 2007 Sep-Oct |
Date Detail:
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Created Date: 2007-10-26 Completed Date: 2008-01-23 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9804508 Medline TA: Reg Anesth Pain Med Country: United States |
Other Details:
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Languages: eng Pagination: 393-8 Citation Subset: IM |
Affiliation:
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Department of Anesthesia, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Analgesia, Patient-Controlled Analgesics, Opioid / administration & dosage, adverse effects, therapeutic use Anesthetics, Local / administration & dosage, adverse effects, therapeutic use Arthroplasty, Replacement, Hip* Bupivacaine / administration & dosage, adverse effects, therapeutic use Female Humans Lumbosacral Plexus* Male Middle Aged Morphine / administration & dosage, adverse effects, therapeutic use Nerve Block* / adverse effects Pain Measurement / drug effects Pain, Postoperative / drug therapy* Patient Satisfaction Postoperative Nausea and Vomiting / epidemiology Sample Size Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Opioid; 0/Anesthetics, Local; 2180-92-9/Bupivacaine; 57-27-2/Morphine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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