Continuous Posterior Lumbar Plexus Nerve Block Versus Periarticular Injection with Ropivacaine or Liposomal Bupivacaine for Total Hip Arthroplasty: A Three-Arm Randomized Clinical Trial

The Journal of Bone and Joint Surgery. American Volume
Rebecca L JohnsonSandra L Kopp

Abstract

Debate surrounds the issue of whether peripheral nerve blockade or periarticular infiltration (PAI) should be employed within a contemporary, comprehensive multimodal analgesia pathway for total hip arthroplasty. We hypothesized that patients treated with a continuous posterior lumbar plexus block (PNB) would report less pain and consume less opioid medication than those treated with PAI. This investigator-initiated, independently funded, 3-arm randomized clinical trial (RCT) performed at a single high-volume institution compared postoperative analgesia interventions for elective, unilateral primary total hip arthroplasty: (1) PNB; (2) PAI with ropivacaine, ketorolac, and epinephrine (PAI-R); and (3) PAI with liposomal bupivacaine, ketorolac, and epinephrine (PAI-L) using computerized randomization. The primary outcome was maximum pain during the morning (06:00 to 12:00) of the first postoperative day (POD) on an ascending numeric rating scale (NRS) from 0 to 10. Pairwise treatment comparisons were performed using the rank-sum test, with a p value of <0.017 indicating significance (Bonferroni adjusted). A sample size of 150 provided 80% power to detect a difference of 2.0 NRS units. We included 159 patients (51, 54, and 54 pati...Continue Reading

Associated Clinical Trials

Sep 16, 2014·Rebecca L Johnson, MD, Rebecca L Johnson, MD

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Citations

Feb 2, 2017·The Cochrane Database of Systematic Reviews·Thomas W HamiltonHemant G Pandit
Nov 1, 2017·The Cochrane Database of Systematic Reviews·Joanne GuaySandra Kopp
Oct 7, 2018·Medicine·Maria Laura De LucaMaria Grazia Benedetti
Jun 26, 2018·Clinical Orthopaedics and Related Research·Naoyuki HirasawaSachiyuki Tsukada
Sep 21, 2018·The Journal of Bone and Joint Surgery. American Volume·Mengnai Li, Andrew H Glassman
Apr 27, 2021·The Journal of the American Academy of Orthopaedic Surgeons·Bailey J RossWilliam F Sherman
May 21, 2021·Anaesthesia·M AngerUNKNOWN PROSPECT Working Group* and the European Society of Regional Anaesthesia and Pain Therapy

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