Original Articles
Lumbar paravertebral nerve block in the management of pain after total hip and knee arthroplasty: A randomized controlled clinical trial*,**

https://doi.org/10.1054/arth.2002.31079Get rights and content

Abstract

The accepted mode of pain management after total hip or knee arthroplasty is patient-controlled analgesia. This study evaluates the efficacy of lumbar paravertebral nerve block in diminishing postoperative pain when used as an adjunct to patient-controlled analgesia. A total of 115 arthroplasty patients received postoperatively a lumbar paravertebral nerve block (block, n = 57) or a sham procedure (control, n = 58). The block group required approximately 10 mg less morphine for pain control than the control group during the first 4 hours postoperatively (P<.001). There were no significant differences in morphine use between the groups 4 to 24 hours postoperatively. Visual analog scale pain score measurements at 4, 8, and 24 hours did not differ significantly between the groups. Paravertebral nerve block of the lumbar plexus is an invasive procedure with some risk. Considering the added risk and minimal benefits, routine use of this procedure is not supported. Copyright 2002, Elsevier Science (USA). All rights reserved.

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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*

No benefits or funds were received in support of this study.

**

Reprint requests: Earl R. Bogoch, MD, St. Michael's Hospital, 55 Queen Street East, Suite 800, Toronto, Ontario, Canada, M5C 1R6.

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