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Greater analgesic effect with intermittent compared with continuous mode of lumbar plexus block for total hip arthroplasty: a randomized controlled trial
  1. Hironobu Ueshima,
  2. Noriko Tanaka and
  3. Hiroshi Otake
  1. Anesthesiology, Showa University, Tokyo, Japan
  1. Correspondence to Dr Hironobu Ueshima, Anesthesiology, Showa University, Shinagawa-ku 142-8666, Japan; ueshimhi{at}gmail.com

Abstract

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.

  • lower extremity
  • acute pain
  • continuous peripheral techniques
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Footnotes

  • Contributors Study design/planning: HU and HO. Study conduct: all authors. Data analysis: HU and HO. Writing paper: HU. Revising paper: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval An approval number 2201 was approved by the Showa University Hospital Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note A clinical trial number: University Hospital Medical Information Network (UMIN) ID number 000025774.

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