ANALGESIA AFTER TOTAL HIP ARTHROPLASTY: CONTINUOUS EPIDURAL BLOCK VERSUS CONTINUOUS LUMBAR PLEXUS BLOCK

Background and Objectives: Continuous epidural block (CEB) is commonly used to control postoperative pain, but continuous lumbar plexus block (CLPB) has recently been shown to give an effective postoperative analgesia following total hip arthroplasty. The aim of this prospective study was to evaluate the effectiveness of CLPB with only a local anesthetic compared with CEB for postoperative analgesia after total hip arthroplasty. We also compared motor blockade, the feasibility of performing the technique, and complications of opioid-related side effects. Methods: Thirty-two patients who underwent total hip arthroplasty surgery were included in the study. The subjects were randomly assigned to the CEB group (n=16; epidural block with 6ml of 0.5% ropivacaine with 100 /g fentanyl) or the CLPB group (n=16; lumbar plexus block with 25ml of 0.375% ropivacaine). Regional anesthesia procedure time, intraoperative blood loss, and the need for supplemental ephedrine were recorded. Postoperatively, nurse controlled analgesia was adopted with pentazocine given on demand. Patient satisfaction with analgesia, opioid-related side effects and complications were recorded. Results: CEB significantly reduced pain scores at 4, 8, 16, 24 and 72 h at rest and at 16 h during physiotherapy compared with CLPB. Patients in the CEB group had higher motor blockade scores, but there was no significant difference in pentazocine consumption, patient satisfaction, opioidrelated side effects or complications between the two analgesic techniques. Conclusion: Continuous epidural block is more effective than continuous lumbar plexus block for analgesia after hip arthroplasty surgery.