Anesthesia and postoperative analgesia during unilateral lower-extremity fracture surgeries using multiple injections through catheters beside the lumbar plexus or sciatic nerve

• Main Authors: Zhang X, Zhou Y, Chen L, Wang Q, Ni J, Liu L, Hu C, Xu X
• Format: Article
• Language: English
• Published: Dove Medical Press 2013-07-01
• Series: Therapeutics and Clinical Risk Management
• Online Access: http://www.dovepress.com/anesthesia-and-postoperative-analgesia-during-unilateral-lower-extremi-a13746
• ISSN: 1176-6336; 1178-203X

Xuezheng Zhang,1 Ying Zhou,1 Limei Chen,1 Quanguang Wang,1 Jianwu Ni,1 Le Liu,1 Chenggang Hu,2 Xuzhong Xu11Department of Anesthesiology, First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, People&rsquo;s Republic of China; 2Department of Anesthesia, Pomerado Hospital, Poway, CA, USAObjective: To compare the clinical effects of anesthesia and postoperative analgesia for patients with unilateral lower-extremity fracture between multiple injections through catheters beside the lumbar plexus or sciatic nerve and continuous epidural analgesia.Methods: Seventy patients with unilateral lower-extremity fracture scheduled for internal fixation were randomly divided into group N (n = 35) and group E (n = 35). Patients in group N received combined lumbar plexus and sciatic nerve block, then a catheter was inserted into the psoas compartment or beside the sciatic nerve, according to the surgical site, and 25 mL 0.375% ropivacaine was injected into patients in group N through the peripheral nerve catheter 12 hours after operation. Patients in group E received combined spinal and epidural anesthesia, and when the operation was complete kept the epidural catheter and received patient-controlled epidural analgesia with an analgesia pump.Results: The visual analog scores of patients at each time point in the two groups showed no significant difference (P > 0.05). Mean arterial pressure at 30 minutes after anesthesia and 4 hours postoperation in group E decreased significantly and was significantly lower than group N (P < 0.01). Group E had significantly higher rate of urinary retention than group N (P < 0.05), and the time of first food intake of patients in group N was significantly shorter than in group E (P < 0.001).Conclusion: For patients with unilateral lower-extremity fracture receiving internal fixation, multiple injections through catheters beside the lumbar plexus or sciatic nerve can provide adequate postoperative analgesia, with very few adverse effects.Keywords: lumbar plexus, sciatic nerve, catheterization, lower extremity, analgesia