Continuous femoral versus posterior lumbar plexus nerve blocks for XXXX after hip arthroplasty: a randomized, controlled study.

@entity1 @entity1337 @entity1342 @entity158 @entity282 @entity616
BACKGROUND: Hip arthroplasty frequently requires potent postoperative @entity1337 , often provided with an epidural or posterior lumbar plexus local anesthetic infusion. However, American Society of Regional Anesthesia guidelines now recommend against epidural and continuous posterior lumbar plexus blocks during administration of various perioperative anticoagulants often administered after hip arthroplasty. A continuous femoral @entity616 is a possible analgesic alternative, but whether it provides comparable @entity1337 to a continuous posterior lumbar @entity616 after hip arthroplasty remains unclear. We therefore tested the hypothesis that differing the catheter insertion site (femoral versus posterior lumbar plexus) after hip arthroplasty has no impact on postoperative @entity1337 . METHODS: Preoperatively, subjects undergoing hip arthroplasty were randomly assigned to receive either a femoral or a posterior lumbar plexus stimulating catheter inserted 5 to 15 cm or 0 to 1 cm past the needle tip, respectively. Postoperatively, @entity1 received perineural @entity1342 , 0.2% (basal 6 mL/hr, bolus 4 mL, 30-minute lockout) for at least 2 days. The primary end point was the average daily @entity158 scores as measured with a numeric rating scale (0-10) recorded in the 24-hour period beginning at 07:30 the morning after surgery, excluding twice-daily physical therapy sessions. Secondary end points included @entity158 during physical therapy, ambulatory distance, and supplemental analgesic requirements during the same 24-hour period, as well as satisfaction with @entity1337 during hospitalization. RESULTS: The mean (SD) @entity158 scores for subjects receiving a femoral infusion (n = 25) were 3.6 (1.8) versus 3.5 (1.8) for @entity1 receiving a posterior lumbar plexus infusion (n = 22), resulting in a group difference of 0.1 (95% confidence interval -0.9 to 1.2; P = 0.78). Because the confidence interval was within a prespecified -1.6 to 1.6 range, we conclude that the effect of the 2 analgesic techniques on @entity282 was equivalent. Similarly, we detected no differences between the 2 treatments with respect to the secondary end points, with one exception: subjects with a femoral catheter ambulated a median (10th-90th percentiles) 2 (0-17) m the morning after surgery, in comparison with 11 (0-31) m for subjects with a posterior lumbar plexus catheter (data nonparametric; P = 0.02). CONCLUSIONS: After hip arthroplasty, a continuous femoral @entity616 is an acceptable analgesic alternative to a continuous posterior lumbar @entity616 when using a stimulating perineural catheter. However, early ambulatory ability suffers with a femoral infusion.
