title: Anesthesia and postoperative analgesia during unilateral lower-extremity fracture surgeries using multiple injections through catheters beside the lumbar plexus or sciatic nerve.
abstract: OBJECTIVE
  To compare the clinical effects of anesthesia and postoperative analgesia for patients with unilateral lower-extremity fracture between multiple injections through catheters beside the lumbar plexus or sciatic nerve and continuous epidural analgesia.
  
  
  METHODS
  Seventy patients with unilateral lower-extremity fracture scheduled for internal fixation were randomly divided into group N (n = 35) and group E (n = 35). Patients in group N received combined lumbar plexus and sciatic nerve block, then a catheter was inserted into the psoas compartment or beside the sciatic nerve, according to the surgical site, and 25 mL 0.375% ropivacaine was injected into patients in group N through the peripheral nerve catheter 12 hours after operation. Patients in group E received combined spinal and epidural anesthesia, and when the operation was complete kept the epidural catheter and received patient-controlled epidural analgesia with an analgesia pump.
  
  
  RESULTS
  The visual analog scores of patients at each time point in the two groups showed no significant difference (P > 0.05). Mean arterial pressure at 30 minutes after anesthesia and 4 hours postoperation in group E decreased significantly and was significantly lower than group N (P < 0.01). Group E had significantly higher rate of urinary retention than group N (P < 0.05), and the time of first food intake of patients in group N was significantly shorter than in group E (P < 0.001).
  
  
  CONCLUSIONS
  For patients with unilateral lower-extremity fracture receiving internal fixation, multiple injections through catheters beside the lumbar plexus or sciatic nerve can provide adequate postoperative analgesia, with very few adverse effects.
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, People's Republic of China.
authors.forename: Xuezheng
authors.initials: X
authors.lastname: Zhang
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhou
authors.forename: Limei
authors.initials: L
authors.lastname: Chen
authors.forename: Quanguang
authors.initials: Q
authors.lastname: Wang
authors.forename: Jianwu
authors.initials: J
authors.lastname: Ni
authors.forename: Le
authors.initials: L
authors.lastname: Liu
authors.forename: Chenggang
authors.initials: C
authors.lastname: Hu
authors.forename: Xuzhong
authors.initials: X
authors.lastname: Xu
keywords: analgesia; catheterization; lower extremity; lumbar plexus; sciatic nerve
references.citation: Br J Anaesth. 2008 Feb;100(2):154-64
references.pmid: 18211990
references.citation: Reg Anesth Pain Med. 2006 Sep-Oct;31(5):417-21
references.pmid: 16952812
references.citation: Reg Anesth Pain Med. 2004 Mar-Apr;29(2):102-9
references.pmid: 15029544
references.citation: Reg Anesth Pain Med. 2005 Jan-Feb;30(1):4-35
references.pmid: 15690265
references.citation: Orthopedics. 2003 Aug;26(8 Suppl):s865-71
references.pmid: 12934742
references.citation: Eur J Anaesthesiol. 2008 Jun;25(6):502-7
references.pmid: 18298872
references.citation: Rev Bras Anestesiol. 2012 Jan-Feb;62(1):28-38
references.pmid: 22248763
references.citation: Acta Anaesthesiol Scand. 2005 Sep;49(8):1048-55
references.pmid: 16095441
references.citation: Can J Anaesth. 2004 Jan;51(1):52-6
references.pmid: 14709461