Effects of Epidural Analgesia and Continuous Lumbar Plexus Block on Functional Rehabilitation after Total Hip Arthroplasty

• Published in: Revista brasileira de anestesiologia 2009-09, Vol.59 (5), p.531-544
• Main Authors: Duarte, Leonardo Teixeira Domingues, Beraldo, Paulo Sérgio Siebra, Saraiva, Renato Ângelo
• Format: Article
• Language: eng ; por
• Subjects: Analgesia, Epidural; ANALGESIA, Postoperative: patient-controlled, epidural, lumbosacral plexus; ANALGESIA, Pós-operatória: controlada pelo paciente, peridural, plexo lombossacral; Arthroplasty, Replacement, Hip - rehabilitation; CIRURGIA, Ortopédica: artroplastia quadril; Female; Humans; Lumbosacral Plexus; Male; Middle Aged; Nerve Block - methods; POSTOPERATIVE RECOVERY: functional rehabilitation; RECUPERAÇÃO PÓS-OPERATÓRIA: reabilitação funcional; SURGERY, Orthopedic: hip arthroplasty
• ISSN: 0034-7094; 1806-907X
• DOI: 10.1016/S0034-7094(09)70078-9

Pain after total hip arthroplasty (THA) is severe and it is aggravated by movements, which requires an effective analgesic technique that allows early mobilization, participation in rehabilitation activities, and fast functional recovery. The objective of this study was to compare the effects of epidural and perineural patient-controlled analgesia (PCA) of the lumbar plexus on functional rehabilitation of patients undergoing THA. Patients classified as physical status ASA I to III were randomly divided into two groups: Epidural and Lumbar. For THA, patients underwent continuous epidural lumbar block with 0.5% ropivacaine (Epidural) or continuous lumbar plexus block with 0.5% ropivacaine (Lumbar). In the recovery room, PCA with infusion of 0.2% ropivacaine (Lumbar) or 0.2% ropivacaine + fentanyl 3 μg.mL-1 (Epidural) was instituted. Analgesic efficacy in the first 48 hours after THA (pain scores, rescue morphine consumption, and bolus of the PCA pump) was compared between both groups. Different postoperative rehabilitation parameters were analyzed. Forty-one patients underwent statistical analysis. Resting pain scores were similar in both groups. Despite more effective control of dynamic pain in the Epidural group and the greater, more frequent, and earlier morphine consumption in the Lumbar group, rehabilitation parameters evaluated did not differ in both groups. Analgesia techniques did not affect rehabilitation failures. The greater effectivity of epidural analgesia did not translate in improvement of the rehabilitation process nor did it decrease the time necessary to achieve end goals. A dor após artroplastia total do quadril (ATQ) é intensa e agravada pelas mobilizações, o que demanda técnica analgésica eficaz e que permita mobilidade precoce, participação nas atividades de reabilitação e rápida recuperação funcional. O objetivo do estudo foi comparar os efeitos das técnicas de analgesia controlada pelo paciente (ACP) pelas vias peridural e perineural do plexo lombar sobre a reabilitação funcional em pacientes submetidos à ATQ. Pacientes estado físico ASA I a III foram alocados aleatoriamente nos grupos Peridural e Lombar. Para a ATQ, foi realizada anestesia peridural lombar contínua com ropivacaína a 0,5% (Peridural) ou bloqueio contínuo do plexo lombar com ropivacaína a 0,5% (Lombar). Na sala de recuperação, iniciou-se ACP com infusão de ropivacaína a 0,2% (Lombar) ou ropivacaína a 0,2% + fentanil 3 μg.mL-1 (Peridural). A eficácia da analgesia nas pr