Background & Aims

Continuous epidural analgesia (CEA) provides effective postoperative analgesia but associated with side effects. Continuous peripheral nerve block (CPNB) facilitates early ambulation.
The purpose of this study was to compare the postoperative analgesic requirement of opioid as rescue analgesia, postoperative pain scores, time to ambulation, perioperative blood pressures, length of hospital stay (LOS), and adverse event rates.

Methods

This was a double-blind prospective study of adult orthopaedic patients (ages 18 – 65 years) undergoing unilateral lower limb surgery (25 CEA and 25 CPNB).
For patients with CEA group, combined spinal epidural (CSE) anaesthesia was stablished before surgical incision. For CSE, B Braun Espocan® CSE Needle System was used.
For patients with CPNB group, spinal anaesthesia was provided for intraoperative anaesthesia. Ultrasound guided peripheral nerve block and catheter (SOLO-DEX Fascile®) placement was done after the surgery.
In both groups intraoperative spinal anaesthesia was established with Bupivacaine heavy 0.5%.
Ropivacaine 0.1% was used in both groups for continuous infusion in postoperative period. Pain was assessed 4 hourlies with numerical pain rating scale (NPRS). If NPRS > 4, Injection Morphine 1 mg/kg IV was prescribed.
Readiness for ambulation was also checked 4 hourlies.
The student’s t-test were used and p-values < 0.05 were considered significant.

Results

There were no statistically significant differences in demographics or the American Society of Anaesthesiologists (ASA) grade.
There were no significant differences in postoperative rescue analgesic requirements, or pain scores on any postoperative day.
The CEA group had a longer time to ambulation (62.7 ± 4.93 hours versus 32.5 ± 4.69 hours, p > 0.05).
The CEA group demonstrated more postoperative hypotension (MAP: 64.7 ± 3.6 mmHg) than CPNB group (MAP: 76.8 ± 8.3 mmHg) with p > 0.05.
There was a significant difference in the length of stay between the CEA and CPNB groups (4.98 versus 2.93, p > 0.05).
There was no statistically significant difference between the rates of pruritus, light-headedness, and altered mental status.
The CEA group demonstrated higher rates of constipation (67.9% versus 5.3%, p > 0.05), urinary retention (45.8% versus 0%, p > 0.05).

Conclusions

CPNB and CEA demonstrated equivalent postoperative opioid use after unilateral lower extremity surgery. A lower complication rate and a decreased time to ambulation were seen in the CPNB group. A prospective multicentre study could further facilitate the incorporation of CPNB in postoperative pain management protocol in Bangladesh.

References

1.Vij N, Singhal N R, Trif D, et al. (June 14, 2023) Continuous Epidural Analgesia Versus Continuous Peripheral Nerve Block in Unilateral Lower Extremity Pediatric Orthopedic Surgery: A Matched Case Comparison Study. Cureus 15(6): e40412. doi:10.7759/cureus.40412
2.Vishwanatha S, Kalappa S. Continuous Femoral Nerve Blockade versus Epidural Analgesia for Postoperative Pain Relief in Knee Surgeries: A Randomized Controlled Study. Anesth Essays Res. 2017;11(3):599-605. doi:10.4103/0259-1162.206852
3.Fowler SJ, Symons JS, Sabato S, Myles PS. Epidural analgesia compared with peripheral nerve blockade after major knee surgery. A systematic review and meta-analysis of randomized trials. Br J Anaesth. 2008;100:154–64
4.Balavenkatasubramanian J. Continuous peripheral block: The future of the regional anesthesia? Indian JAnesth. 2008;52:506–16

Presenting Author

Lutful Aziz

Poster Authors

Lutful Aziz

MBBS, FCPS (Anaesthesia, PhD

Evercare Hospital Dhaka

Lead Author

Topics

  • Treatment/Management: Interventional Therapies – Injections/Blocks