title: Lumbar paravertebral nerve block in the management of pain after total hip and knee arthroplasty: a randomized controlled clinical trial.
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.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada.
authors.forename: Earl R
authors.initials: ER
authors.lastname: Bogoch
authors.forename: Marjorie
authors.initials: M
authors.lastname: Henke
authors.forename: Terence
authors.initials: T
authors.lastname: Mackenzie
authors.forename: Eli
authors.initials: E
authors.lastname: Olschewski
authors.forename: Nizar N
authors.initials: NN
authors.lastname: Mahomed
mesh_terms: D016058:Analgesia, Patient-Controlled; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D002045:Bupivacaine; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D009020:Morphine; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*
chemical_list: D009020:Morphine; D002045:Bupivacaine