You are here

Article Text

Article menu
Download PDFPDF
Regional Anesthesia and Acute Pain: Original Article
Complications After Continuous Posterior Lumbar Plexus Blockade for Total Hip Arthroplasty: A Retrospective Cohort Study
  1. Catherine W. Njathi, MD*,
  2. Rebecca L. Johnson, MD*,
  3. Ruple S. Laughlin, MD†,
  4. Darrell R. Schroeder, MS‡,
  5. Adam K. Jacob, MD* and
  6. Sandra L. Kopp, MD*
  1. Departments of *Anesthesiology and Perioperative Medicine, †Neurology, and ‡Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN
  1. correspondence: Catherine W. Njathi, MD, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, 200 First St SW, Rochester, MN 55905 (e-mail: njathi.catherine{at}mayo.edu).

Abstract

Background and Objectives While benefits of regional anesthesia in total hip arthroplasty (THA) are well documented, data describing the incidence of complications related to the use of posterior lumbar plexus blockade for THA remain limited. Our primary aim was to evaluate the incidence of infectious, bleeding, and neurological complications related specifically to the use of continuous posterior lumbar plexus block for elective THA.

Methods We reviewed the electronic medical records of all adult patients who underwent elective THA with continuous posterior lumbar plexus blockade between December 1, 2004, and April 30, 2015, using the Mayo Clinic Total Joint Registry. All complications were verified via manual chart review by 2 reviewers. Patient demographics, type of surgery, and complications were analyzed.

Results A total of 9649 patients who underwent 11,395 THA procedures met the inclusion criteria. There were 8686 (76.2%) primary and 2709 (23.8%) revision THAs. There were no block-related infections (0.00%; 95% confidence interval [CI], 0.00%–0.03%) and only 1 block-related hematoma (0.01%; 95% CI, 0.00%–0.05%) in a patient with multiple risk factors for bleeding. There were 60 (0.53%; 95% CI, 0.40%–0.68%) perioperative nerve injuries. Forty-three were in the sciatic distribution (71.67%; incidence, 0.38%). Although there were no documented overt iatrogenic nerve injuries, the posterior lumbar plexus blockade could not be excluded as the potential cause in 9 cases (incidence, 0.08%) based on clinical distribution or electromyographic findings.

Conclusions In our large, single-center cohort study, we report no catheter-related infections, whereas catheter-related hemorrhagic and neurological complications also appear to be rare.

https://doi.org/10.1097/AAP.0000000000000589

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Footnotes

    • The authors declare no conflict of interest.

      Institutional review board approved this minimal-risk retrospective study (ID 15-000980).

      C.W.N. helped design, conduct the study, collect and analyze the data, and prepare the manuscript. She attests to the integrity of the original data and the analysis reported in this manuscript. C.W.N. is the archival author. R.L.J. conceived the study design, mentored the first author during the project, helped conduct the study, analyze data, and prepare the manuscript. She attests to the integrity of the original data and the analysis reported in this manuscript. R.S.L helped collect and analyze data and prepare the manuscript. R.S.L. attests to the integrity of the data and analysis reported in this article. D.R.S. helped design the study and analyze the data. A.K.J. helped design the study and prepare the final manuscript. S.L.K helped design the study, analyzed data, and prepare the manuscript. All authors approved the final manuscript.

      Internal funds were received from the Department of Anesthesiology and Perioperative Medicine (CCaTS grant UL1TR000135).

      This work was presented in part at the American Society of Regional Anesthesia and Pain Medicine's 41st Annual Regional Anesthesiology and Acute Pain Medicine meeting in New Orleans, Louisiana, March 31 to April 2, 2016.