The Journal of arthroplasty
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Randomized Controlled Trial Clinical Trial
Lumbar paravertebral nerve block in the management of pain after total hip and knee arthroplasty: a randomized controlled clinical trial.
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). ⋯ 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.
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This case series describes the use of continuous lumbar plexus block with sciatic nerve block as an alternative anesthetic for total hip arthroplasty (THA). A retrospective chart review was performed on 10 consecutive patients who underwent THA at Walter Reed Army Medical Center using continuous lumbar plexus block and sciatic nerve block for anesthesia. ⋯ Peripheral nerve block may provide superior intraoperative outcomes, as suggested by lower operative blood loss and potentially lower transfusion exposure. Lumbar plexus block with perineural catheter and sciatic nerve block with perioperative sedation is an effective alternative to general anesthesia for THA.
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This study evaluated the improvement in range of motion after revision total knee arthroplasty (TKA) in a consecutive series of patients with TKAs presenting with pain and limited range of motion. Eleven stiff (range of motion <70 degrees ) and painful TKAs were revised with a posterior stabilized condylar prosthesis and reviewed after an average of 37.6 months (range, 24-53 months). ⋯ Pain scores improved from 4.5 to 44.1, and all 11 patients were satisfied. This study shows that knee range of motion can improve significantly after revision TKA.
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Scheduled preoperative and postoperative analgesia should be offered in a multimodal management model. By a combined drug synergy effect, the central nervous system, afferent pathways, and peripheral wound site are modified collectively. ⋯ The first more recent group used epidural anesthesia, and the second group used spinal anesthesia. Both protocols featured the use of cyclooxygenase-2-inhibiting anti-inflammatory medication administered for 2 weeks preoperatively and continued for 10 days postoperatively and patient-controlled analgesia for 24 hours followed by scheduled oral opioids.
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A total of 200 consecutive patients who underwent primary total knee or hip arthroplasty were reviewed to assess the efficacy of perioperative blood salvage and retransfusion. Five of 132 (3.8%) patients undergoing total knee arthroplasty and 3 of 68 (4.4%) patients undergoing total hip arthroplasty required allogeneic transfusion in addition to retransfusion of salvaged autologous blood. ⋯ The risk of requiring allogeneic transfusion was 22% (6 of 27) in patients with a preoperative hematocrit of