Lumbar plexus block versus suprainguinal fascia iliaca block for total hip arthroplasty: A single-blinded, randomized trial

Study objective: Comparison of ultrasound-guided lumbar plexus block (LPB) and suprainguinal fascia iliaca block (SIFIB) in patients undergoing total hip arthroplasty (THA). Design: Randomized equivalence trial. Setting: University Hospital. Patients: Sixty patients undergoing primary THA. Interventions: Patients were randomly allocated to receive ultrasound-guided LPB (n = 30) or SIFIB (n = 30). The local anesthetic agent (40 mL of levobupivacaine 0.25% with epinephrine 5 mu g/mL) and block adjuvant (4 mg of intravenous dexamethasone) were identical in all subjects. Postoperatively, all patients received patient-controlled intravenous analgesia (morphine) as well as acetaminophen and ketoprofen during 48 h. Measurements: A blinded investigator recorded morphine consumption at 24 and 48 h as well as time to first morphine request, pain scores at 3, 6, 12, 24 and 48 h, incidence of adverse events, time to readiness for discharge, and length of hospital stay. The blinded investigator also carried out sensorimotor block assessment at 3, 6 and 24 h using a 10-point sensorimotor composite scale. Main results: No intergroup differences were found in terms of cumulative morphine consumption at 24 h (95% CI: - 4.0 mg to 2.0 mg) and 48 h (95% CI, - 5.0 mg to 2.0 mg) or time to first morphine request. Furthermore, pain scores were similar at all time intervals after 3 h. There were no intergroup differences in terms of composite sensorimotor scores at 3 and 6 h. However, SIFIB lasted longer than lumbar plexus block as evidenced by a higher composite score at 24 h. No intergroup differences were found in terms of complications. Compared with LPB, SIFIB was associated with shorter time to readiness for discharge (3 [1-4] vs. 2 [1-3] days; P = 0.042) and length of hospital stay (3 [2-5] vs. 3 [2-4] days; P = 0.048). Conclusions: For THA, no differences were found between LPB and SIFIB in terms of breakthrough morphine requirement and pain control. However, SIFIB resulted in a longer block and was associated with shorter time to readiness for discharge as well as decreased hospital stay

The Effect of Pulsed Radiofrequency Combined with a Transforaminal Epidural Steroid Injection on Chronic Lumbar Radicular Pain: A Randomized Controlled Trial

Background. Pulsed radiofrequency lesioning (PRFL) of the dorsal root ganglion (DRG) can modulate neural pathways and provide prolonged relief of neuropathic pain, with limited evidence for chronic lumbosacral radicular pain (CLRP). Objective. This study compared the effect of PRFL combined with transforaminal epidural steroid injection (TFESI) to TFESI alone on CLRP. Methods. Forty adults with chronic radicular pain of at least six-month duration were randomly allocated to undergo either a PRFL of the affected DRG followed by a TFESI (treatment group) or a TFESI alone (control group). Participants and assessors were blinded to the allocation and outcomes were assessed at 1, 2, 3, and 4 months. Outcomes. Pain intensity (visual analog score, VAS) was the primary outcome and quality of life (QOL) as measured by the SF-36 was a secondary outcome. Results. There was no difference in baseline characteristics between groups. VAS was significantly lower in the treatment group at 2-month and 3-month but not 4-month follow-up. QOL measurements did not differ between groups. Conclusions. PRFL of the lumbosacral DRG combined with TFESI showed a modest advantage over TFESI alone in reducing pain intensity; however, this did not persist beyond the 3-month follow-up. There was no effect on QOL.</jats:p