Harjit Sharma1, Sukanya Mitra1, Jasveer Singh1, Sandeep Gupta2, Sudhir Garg2. 1. Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India. 2. Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
Abstract
BACKGROUND:Patients undergoing total hip replacement (THR) experience severe postoperative pain. The advantage of pain relief by continuous epidural anesthesia (CEA) is offset by various adverse effects. Ultrasound guided (USG) continuous lumbar plexus block (LPB) has emerged as an alternative approach for postoperative analgesia in patients undergoing THR, especially where epidural is difficult or contraindicated. METHODS: This randomized controlled trial compared USG-LPB with CEA for postoperative pain reliefuntil 48 hours in patients undergoing THR, with 0.5% ropivacaine (15 mL) used as boluses for both CEA and LPB. RESULTS: The mean time to the first bolus was 380.60 ± 77.66 min in the LPB group whereas it was 307.40 ± 83.60 min in the epidural group (P = 0.002). Thus, patients in the LPB group took more than one hour longer than the epidural group to take their first bolus, which is clinically meaningful besides being statistically significant. The pain score on movement was also significantly lower, and patient satisfaction higher, in the LPB group. There were no significant intergroup differences about motor power, pain at rest, total ropivacaine consumption, and adverse effects. CONCLUSION: USG-LPB is an effective alternative to CEA combined with general anesthesia for postoperative analgesia after THR.
RCT Entities:
BACKGROUND:Patients undergoing total hip replacement (THR) experience severe postoperative pain. The advantage of pain relief by continuous epidural anesthesia (CEA) is offset by various adverse effects. Ultrasound guided (USG) continuous lumbar plexus block (LPB) has emerged as an alternative approach for postoperative analgesia in patients undergoing THR, especially where epidural is difficult or contraindicated. METHODS: This randomized controlled trial compared USG-LPB with CEA for postoperative pain relief until 48 hours in patients undergoing THR, with 0.5% ropivacaine (15 mL) used as boluses for both CEA and LPB. RESULTS: The mean time to the first bolus was 380.60 ± 77.66 min in the LPB group whereas it was 307.40 ± 83.60 min in the epidural group (P = 0.002). Thus, patients in the LPB group took more than one hour longer than the epidural group to take their first bolus, which is clinically meaningful besides being statistically significant. The pain score on movement was also significantly lower, and patient satisfaction higher, in the LPB group. There were no significant intergroup differences about motor power, pain at rest, total ropivacaine consumption, and adverse effects. CONCLUSION:USG-LPB is an effective alternative to CEA combined with general anesthesia for postoperative analgesia after THR.