Greater analgesic effect with intermittent compared with continuous mode of lumbar plexus block for total hip arthroplasty: a randomized controlled trial.
Aged
Analgesia, Epidural
Analgesia, Patient-Controlled
Analgesics
Analgesics, Opioid
/ administration & dosage
Anesthetics, Intravenous
/ administration & dosage
Anesthetics, Local
/ administration & dosage
Arthroplasty, Replacement, Hip
Female
Fentanyl
/ administration & dosage
Humans
Lumbosacral Plexus
/ drug effects
Male
Middle Aged
Nerve Block
Pain Management
Pain, Postoperative
acute pain
continuous peripheral techniques
lower extremity
Journal
Regional anesthesia and pain medicine
ISSN: 1532-8651
Titre abrégé: Reg Anesth Pain Med
Pays: England
ID NLM: 9804508
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
07
09
2018
revised:
15
02
2019
accepted:
08
03
2019
pubmed:
6
4
2019
medline:
18
3
2020
entrez:
6
4
2019
Statut:
ppublish
Résumé
Lumbar plexus block (LPB) is an effective perioperative analgesic therapy for patients undergoing total hip arthroplasty (THA). However, the analgesic efficacy of intermittent administration compared with continuous infusion of LPB in patients remains unclear. Forty adult patients who underwent THA were randomly divided into two groups: continuous infusion group (6 mL/hour continuous infusion of levobupivacaine [0.125%] in LPB, n=20) and intermittent infusion group (12 mL of levobupivacaine [0.125%] bolus delivered every 2 hours in LPB, n=20). The primary outcome was the cumulative fentanyl consumption administered for rescue analgesia during the first 48 hours after surgery. Secondary outcomes were the number of demands for rescue analgesia and successfully delivered rescue analgesia; extent of sensory blockade (cold tests); and pain score on the visual analog scale (VAS) at rest and during mobilization during the first 48 hours after surgery. Both the cumulative fentanyl consumption administered for rescue analgesia (mean [SD]: 81.5 [58.5] μg vs 438 [101.2] μg among the intermittent infusion and the continuous infusion groups, respectively) and the number of demanded and delivered fentanyl boluses for rescue analgesia were lower in intermittent infusion group than in continuous infusion (p<0.001 for both). The extent of sensory blockade remained constant in intermittent infusion group, but gradually narrowed in continuous infusion. VAS was lower in intermittent infusion group than in continuous infusion, except at 1 and 12 hours postoperatively (p<0.05). Greater analgesic effect was achieved using the intermittent mode than the continuous mode of LPB administration.
Sections du résumé
BACKGROUND AND OBJECTIVES
Lumbar plexus block (LPB) is an effective perioperative analgesic therapy for patients undergoing total hip arthroplasty (THA). However, the analgesic efficacy of intermittent administration compared with continuous infusion of LPB in patients remains unclear.
METHODS
Forty adult patients who underwent THA were randomly divided into two groups: continuous infusion group (6 mL/hour continuous infusion of levobupivacaine [0.125%] in LPB, n=20) and intermittent infusion group (12 mL of levobupivacaine [0.125%] bolus delivered every 2 hours in LPB, n=20). The primary outcome was the cumulative fentanyl consumption administered for rescue analgesia during the first 48 hours after surgery. Secondary outcomes were the number of demands for rescue analgesia and successfully delivered rescue analgesia; extent of sensory blockade (cold tests); and pain score on the visual analog scale (VAS) at rest and during mobilization during the first 48 hours after surgery.
RESULTS
Both the cumulative fentanyl consumption administered for rescue analgesia (mean [SD]: 81.5 [58.5] μg vs 438 [101.2] μg among the intermittent infusion and the continuous infusion groups, respectively) and the number of demanded and delivered fentanyl boluses for rescue analgesia were lower in intermittent infusion group than in continuous infusion (p<0.001 for both). The extent of sensory blockade remained constant in intermittent infusion group, but gradually narrowed in continuous infusion. VAS was lower in intermittent infusion group than in continuous infusion, except at 1 and 12 hours postoperatively (p<0.05).
CONCLUSIONS
Greater analgesic effect was achieved using the intermittent mode than the continuous mode of LPB administration.
Identifiants
pubmed: 30948522
pii: rapm-2018-100091
doi: 10.1136/rapm-2018-100091
doi:
Substances chimiques
Analgesics
0
Analgesics, Opioid
0
Anesthetics, Intravenous
0
Anesthetics, Local
0
Fentanyl
UF599785JZ
Types de publication
Clinical Trial
Journal Article
Retracted Publication
Langues
eng
Sous-ensembles de citation
IM
Pagination
632-636Commentaires et corrections
Type : RetractionIn
Informations de copyright
© American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.