Original ArticlesLumbar paravertebral nerve block in the management of pain after total hip and knee arthroplasty: A randomized controlled clinical trial*,**
Section snippets
Methods
A total of 115 patients undergoing primary THA and TKA were recruited from August 1995 to December 1997 at St. Michael's Hospital, Wellesley Site, for admission to a randomized controlled trial to study the efficacy of lumbar paravertebral nerve block in the management of postoperative pain. The protocol was approved by the hospital Research Ethics Committee, and all patients gave informed consent.
The 58 THA patients and 57 TKA patients were assigned randomly to 1 of 2 groups to receive either
Results
As shown in Table 2, the paravertebral nerve block group required approximately 10 mg less morphine than the control group during the first 4 hours postoperatively (P <.001). There were no significant differences in morphine use between block and control groups in the subsequent 4-hour period (4-8 hours) or either of the following 8-hour periods, up to 24 hours.
Patient assessments of the experience of pain, as measured by VAS pain score and administered at 4, 8, and 24 hours, did not differ
Discussion
Lumbar paravertebral nerve block is used selectively for some patients after THA or TKA in a variety of orthopaedic anesthesia and surgery departments. The efficacy of this procedure, used as an adjunct to PCA, has not been shown conclusively. In the current study, paravertebral nerve block was effective in diminishing total morphine dose administered in the 4-hour period immediately after surgery by approximately 50%, or 10 mg. There was no significant measurable effect of paravertebral nerve
Acknowledgements
We thank Dr. Paul Straka, who performed nerve blocks and provided documentation on study patients. We also thank Dagmar Gross, for assistance with the preparation of this manuscript, and the nursing staff of the Post-Anaesthetic Care Unit and Orthopaedic Ward, for collecting data.
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Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review
2009, British Journal of AnaesthesiaCitation Excerpt :RCTs comparing systemic or regional techniques for postoperative analgesia were also included. Studies were excluded if surgery other than a joint arthroplasty was performed, or if both hip and knee arthroplasty were treated as one single study population and data on the patients undergoing knee surgery were not presented separately in the results.9 26 29 35 73 Studies using opioid-only neuraxial techniques were excluded.24 71
Psoas compartment block for lower extremity surgery: A meta-analysis
2008, British Journal of AnaesthesiaCitation Excerpt :The literature search resulted in inclusion of 20 RCT,1 4–6 9 10 13 14 20 21 27 29 30 32 33 35–38 42 one case-controlled study,8 three case series,7 12 24 and six pharmacokinetic studies.11 22 28 34 40 41
Thromboprophylaxis and Peripheral Nerve Blocks in Patients Undergoing Joint Arthroplasty
2008, Journal of ArthroplastyCitation Excerpt :Thromboprophylaxis has been shown to significantly decrease the risk of DVT and PE, and its use has been recommended in patients undergoing total joint arthroplasty, especially during the immediate operative period when patients are at the greatest risk of DVT and PE [12-16]. The use of peripheral nerve blocks, especially continuous techniques, has also been shown to provide effective postoperative pain control after joint arthroplasty [3-5]. Additional advantages of the use of peripheral nerve blocks include the decrease in opioid consumption and associated side effects, as well as the reduction of the hospital length of stay [3].
Recent developments in patient-controlled analgesia
2005, Journal of Pain and Symptom ManagementCitation Excerpt :Relaxation and music reduced pain after gynecologic surgery,145 whereas acupressure was ineffective with respect to postoperative morphine consumption or pain scores.146 Lumbar paravertebral nerve block in the management of pain after total hip and knee arthroplasty was not recommended.147 Contrary to common expectation, long-term advantage associated with preemptive multimodal drug administration (intravenous ketorolac, intra-articular morphine/ropivacaine/epinephrine, and femoral nerve block with ropivacaine) could not be verified in a group of 40 outpatients undergoing anterior cruciate ligament reconstruction.148
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No benefits or funds were received in support of this study.
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Reprint requests: Earl R. Bogoch, MD, St. Michael's Hospital, 55 Queen Street East, Suite 800, Toronto, Ontario, Canada, M5C 1R6.