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Epidural vs. lumbar plexus infusions following total knee arthroplasty: randomized controlled trial

Published online by Cambridge University Press:  01 June 2008

A. Campbell ,
M. McCormick ,
K. McKinlay  and
N. B. Scott
A. Campbell
Affiliation:
Golden Jubilee National Hospital, Department of Perioperative Medicine, Clydebank, Scotland, UK
M. McCormick
Affiliation:
Golden Jubilee National Hospital, Department of Perioperative Medicine, Clydebank, Scotland, UK
K. McKinlay
Affiliation:
Golden Jubilee National Hospital, Department of Perioperative Medicine, Clydebank, Scotland, UK
N. B. Scott*
Affiliation:
Golden Jubilee National Hospital, Department of Perioperative Medicine, Clydebank, Scotland, UK
*
Correspondence to: Nicholas B. Scott, Department of Perioperative Medicine, Golden Jubilee National Hospital, Beardmore Street, Clydebank G81 4HF, Scotland, UK. E-mail: nick.scott@gjnh.scot.nhs.uk; Tel: +141 951 5600; Fax: +141 951 5603
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Summary

Background and objective

Postoperative regional analgesia for total knee replacement can provide excellent pain control and speedy rehabilitation compared with systemic opioid analgesia but the optimal technique to provide best analgesia with minimal adverse effects remains unclear. We carried out an observer-blinded randomized trial of side-directed epidural infusion with lumbar plexus infusion after total knee arthroplasty.

Methods

Sixty patients scheduled for total knee replacement were randomized to receive epidural or lumbar plexus infusions of levobupivacaine and clonidine. Pain, sensory and motor block were assessed at 0, 6, 24 and 48 h postoperatively. Range of knee movement and mobility were assessed on the first and second postoperative days.

Results

No significant differences were detected between the epidural and lumbar plexus groups in 24-h pain scores at rest (median visual analogue scale, 30 mm (interquartile range, 10–45) vs. 39 mm (17–51), P = 0.286), and on movement (48 mm (20–66) vs. 60 mm (47–81), P = 0.068). The only statistically significant difference in pain scores in favour of the epidural groups was at 6 h postoperatively (P < 0.001). Median morphine usage in the epidural group was 0 mg (interquartile range, 0–35) compared with 14.5 mg (0–44) in the lumbar plexus group (P = 0.33). Range of movement (epidural: median 70° (interquartile range, 58–75) vs. lumbar plexus: 70° (50–75), P = 0.79) or mobility was similar between groups. Adverse effects were also similar between groups, apart from a higher incidence of bladder catheterization in the epidural group (37.9% vs. 12.5%, P = 0.04). Conclusions: Lumbar plexus infusion is a reasonable alternative to epidural anaesthesia for total knee arthroplasty.

Keywords

PAIN ACUTE AND POSTOPERATIVEARTHROPLASTY, replacement, kneeANALGESIA EPIDURALLUNBOSACRAL PLEXUSNERVE BLOCK
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 6 , June 2008 , pp. 502 - 507
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.White, PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg 2005; 101: S5–S22.CrossRefGoogle ScholarPubMed
2.Capdevila, X, Barthelet, Y, Biboulet, P. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology 1999; 91: 8–15.CrossRefGoogle ScholarPubMed
3.Singelyn, FJ, Deyaert, M, Joris, D. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg 1998; 87: 88–92.CrossRefGoogle ScholarPubMed
4.Rodgers, A, Walker, N, Schug, S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. Br Med J 2000; 321: 1493.CrossRefGoogle ScholarPubMed
5.Wu, CL, Cohen, SR, Richman, JM. Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis. Anesthesiology 2005; 103: 1079–1088.CrossRefGoogle ScholarPubMed
6.Richman, JM, Liu, SS, Courpas, G. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg 2006; 102: 248–257.CrossRefGoogle ScholarPubMed
7.Bonnet, F, Marret, E. Influence of anaesthetic and analgesic techniques on outcome after surgery. Br J Anaesth 2005; 95: 52–58.CrossRefGoogle ScholarPubMed
8.Ben-David, B, Schmalenberger, K, Chelly, JE. Analgesia after total knee arthroplasty: is continuous sciatic blockade needed in addition to continuous femoral blockade? Anesth Analg 2004; 98: 747–749.CrossRefGoogle ScholarPubMed
9.Singelyn, FJ, Gouverneur, JM. Extended “three-in-one” block after total knee arthroplasty: continuous versus patient-controlled techniques. Anesth Analg 2000; 91: 176–180.Google ScholarPubMed
10.Borghi, B, Agnoletti, V, Ricci, A. A prospective, randomized evaluation of the effects of epidural needle rotation on the distribution of epidural block. Anesth Analg 2004; 98: 1473–1478.CrossRefGoogle ScholarPubMed
11.Macalou, D, Trueck, S, Meuret, P. Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block. Anesth Analg 2004; 99: 251–254.CrossRefGoogle Scholar
12.McNamee, DA, Parks, L, Milligan, KR. Post-operative analgesia following total knee replacement: an evaluation of the addition of an obturator nerve block to combined femoral and sciatic nerve block. Acta Anaesthesiol Scand 2002; 46: 95–99.CrossRefGoogle ScholarPubMed
13.YaDeau, JT, Cahill, JB, Zawadsky, MW. The effects of femoral nerve blockade in conjunction with epidural analgesia after total knee arthroplasty. Anesth Analg 2005; 101: 891–895.CrossRefGoogle ScholarPubMed
14.Zaric, D, Boysen, K, Christiansen, C. A comparison of epidural analgesia with combined continuous femoral-sciatic nerve blocks after total knee replacement. Anesth Analg 2006; 102: 1240–1246.CrossRefGoogle ScholarPubMed
15.Capdevila, X, Macaire, P, Dadure, C. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation. Anesth Analg 2002; 94: 1606–1613.Google ScholarPubMed
16.Turker, G, Uckunkaya, N, Yavascaoglu, B. Comparison of the catheter-technique psoas compartment block and the epidural block for analgesia in partial hip replacement surgery. Acta Anaesthesiol Scand 2003; 47: 30–36.CrossRefGoogle ScholarPubMed
17.Jensen, MP, Chen, C, Brugger, AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 2003; 4: 407–414.CrossRefGoogle ScholarPubMed
18.Choi, PT, Bhandari, M, Scott, J. Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev 2003; No. 3: CD003071.Google Scholar
19.Davies, AF, Segar, EP, Murdoch, J. Epidural infusion or combined femoral and sciatic nerve blocks as perioperative analgesia for knee arthroplasty. Br J Anaesth 2004; 93: 368–374.CrossRefGoogle ScholarPubMed
20.Pham Dang, C, Gautheron, E, Guilley, J. The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement. Reg Anesth Pain Med 2005; 30: 128–133.CrossRefGoogle ScholarPubMed
21.Cook, P, Stevens, J, Gaudron, C. Comparing the effects of femoral nerve block versus femoral and sciatic nerve block on pain and opiate consumption after total knee arthroplasty. J Arthroplasty 2003; 18: 583–586.CrossRefGoogle ScholarPubMed
22.Milligan, KR, Convery, PN, Weir, P. The efficacy and safety of epidural infusions of levobupivacaine with and without clonidine for postoperative pain relief in patients undergoing total hip replacement. Anesth Analg 2000; 91: 393–397.Google ScholarPubMed
23.Carabine, UA, Milligan, KR, Mulholland, D. Extradural clonidine infusions for analgesia after total hip replacement. Br J Anaesth 1992; 68: 338–343.CrossRefGoogle ScholarPubMed
24.Carabine, UA, Milligan, KR, Moore, J. Extradural clonidine and bupivacaine for postoperative analgesia. Br J Anaesth 1992; 68: 132–135.CrossRefGoogle ScholarPubMed
25.Petersen, MS, Collins, DN, Selakovich, WG. Postoperative urinary retention associated with total hip and total knee arthroplasties. Clin Orthop Relat Res 1991; 269: 102–108.CrossRefGoogle Scholar