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Revista Brasileira de Anestesiologia
On-line version ISSN 1806-907X
DUARTE, Leonardo Teixeira Domingues; BERALDO, Paulo Sérgio Siebra and SARAIVA, Renato Ângelo. Effects of epidural analgesia and continuous lumbar plexus block on functional rehabilitation after total hip arthroplasty. Rev. Bras. Anestesiol. [online]. 2009, vol.59, n.5, pp. 531-544. ISSN 1806-907X. http://dx.doi.org/10.1590/S0034-70942009000500002.
BAKGROUND AND OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Keywords : ANALGESIA, Postoperative [patient-controlled]; ANALGESIA, Postoperative [epidural]; ANALGESIA, Postoperative [lumbosacral plexus]; POSTOPERATIVE RECOVERY [functional rehabilitation]; SURGERY, Orthopedic [hip arthroplasty].