[Posterior block of lumbar plexus for postoperative analgesia after hip arthroplasty].
OBJECTIVE
To describe early postoperative analgesic quality from a posterior lumbar plexus block in the psoas compartment, located by neurostimulation. We used a single paramedial puncture at L4, following Chayen's approach, in patients undergoing uncemented hip arthroplasty under subarachnoid anesthesia with 0.5% bupivacaine.


METHODS
Twenty patients were enrolled. We studied pain intensity on a visual analogical (VAS) scale every hour for the first 12 hours and every 2 hours for the next 12. The need for rescue analgesia, specifically non-steroidal anti-inflammatory drugs (NSAIDs) if pain was over 3 on the VAS and for morphine if analgesia was still insufficient. The patients assessed quality of analgesia received on a verbal scale. Complications were also noted.


RESULTS
VAS scores were under 3 throughout the first 11 hours, gradually rising to 4.7 at 24 h. Only 5 patients (2%) needed NSAIDs in the first 12 hours and non needed morphine. Sixteen patients (80%) needed a mean 1.6 doses of NSAIDs and 3 (15%) needed morphine for persistent pain or for pain greater than 5 on the VAS. On the verbal scale, only 10% reported experiencing intense pain during the postoperative period, whereas 90% said they had experienced mild or moderate pain.


CONCLUSIONS
A posterior lumbar plexus block using a single shot gives effective analgesia in the first 12 hours after surgery performed with spinal anesthesia. Continuous infusion through a catheter may provide better analgesia than that observed in this study.
Hevia-Sánchez
V
V
Servicios de Anestesiología y Reanimación, Centro Médico de Asturias, Oviedo.
Bermejo-Alvarez
M A
MA
Hevia-Méndez
A
A
Fervienza
P
P
Franch
M
M
Díaz
M L
ML
D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D006801:Humans; D008160:Lumbosacral Plexus; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology / Q000628:therapy*