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AlMutiri WA, AlMajed E, Alneghaimshi MM, AlAwadh A, AlSarhan R, AlShebel MN, AlMatrody RAM, Hadaddi R, AlTamimi R, Bin Salamah R, AlZelfawi LA, AlBatati SK, AlHarthi A, AlMazroa G, AlHossan AM. Efficacy of Continuous Lumbar Plexus Blockade in Managing Post-Operative Pain after Hip or Femur Orthopedic Surgeries: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3194. [PMID: 38892904 PMCID: PMC11173339 DOI: 10.3390/jcm13113194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Post-operative pain management is essential for optimizing recovery, patient comfort, and satisfaction. Peripheral nerve blockade, or lumbar plexus block (LPB), has been widely used for analgesia and regional anesthesia. This study explored the existing literature to determine the efficacy of continuous lumbar plexus blockade in managing post-operative pain following hip or femur surgery. Methods: Reviewers comprehensively searched electronic databases to identify peer-reviewed scholarly articles reporting the efficacy of lumbar plexus block in managing post-operative pain after orthopedic surgery. The potential articles were carefully selected and assessed for the risk of bias using the Cochrane Collaboration Risk of Bias assessment tool. Data were systematically extracted and analyzed. Results: The literature search yielded 206 articles, 20 of which were randomized controlled trials. Lumbar plexus block demonstrated superior pain relief compared to conventional pain management approaches like general anesthetics. In addition, LPB reduced patients' overall opioid consumption compared to controls, reduced adverse effects, and enhanced functional recovery, which underlines the broader positive impact of meticulous pain management. More patients could walk more than 40 feet after the second day post-operatively among the lumbar plexus group (14.7%) compared to the continuous femoral group (1.3%). Other parameters, including cortisol levels and hemodynamic stability, were evaluated, showing comparable outcomes. Conclusions: Lumbar plexus block is effective in pain management after orthopedic surgery, as shown by the lower pain scores and less opioid consumption. Additionally, patient satisfaction was relatively higher in LPB-treated patients compared to other approaches like general anesthesia.
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Affiliation(s)
- Wijdan A. AlMutiri
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Ebtesam AlMajed
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Muath M. Alneghaimshi
- Orthopaedic Surgery Department, King Fahad Military Medical Complex, Dhahran 31932, Saudi Arabia; (M.M.A.); (S.K.A.); (A.M.A.)
| | - Afnan AlAwadh
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Reem AlSarhan
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Malak N. AlShebel
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia;
| | | | - Rafa Hadaddi
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia;
| | - Reem AlTamimi
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Rawan Bin Salamah
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Lama A. AlZelfawi
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Saud K. AlBatati
- Orthopaedic Surgery Department, King Fahad Military Medical Complex, Dhahran 31932, Saudi Arabia; (M.M.A.); (S.K.A.); (A.M.A.)
| | - Alanood AlHarthi
- College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia; (E.A.); (A.A.); (R.A.); (R.A.); (R.B.S.); (L.A.A.); (A.A.)
| | - Ghayda AlMazroa
- College of Medicine, Qassim University, Qassim 51452, Saudi Arabia;
| | - Abdullah M. AlHossan
- Orthopaedic Surgery Department, King Fahad Military Medical Complex, Dhahran 31932, Saudi Arabia; (M.M.A.); (S.K.A.); (A.M.A.)
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Hung KC, Huang YT, Kuo JR, Hsu CW, Yew M, Chen JY, Lin MC, Chen IW, Sun CK. Elevated Surgical Pleth Index at the End of Surgery Is Associated with Postoperative Moderate-to-Severe Pain: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12092167. [PMID: 36140567 PMCID: PMC9498235 DOI: 10.3390/diagnostics12092167] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Despite acceptance of the surgical pleth index (SPI) for monitoring the intraoperative balance between noxious stimulation and anti-nociception under general anesthesia, its efficacy for predicting postoperative moderate-to-severe pain remains unclear. We searched electronic databases (e.g., Google Scholar, MEDLINE, Cochrane Library, and EMBASE) to identify articles focusing on associations of SPI at the end of surgery with immediate moderate-to-severe pain in the postanesthesia care unit from inception to 7 July 2022. A total of six observational studies involving 756 adults published between 2016 and 2020 were eligible for quantitative syntheses. Pooled results revealed higher values of SPI in patients with moderate-to-severe pain than those without (mean difference: 7.82, 95% CI: 3.69 to 11.95, p = 0.002, I2 = 46%). In addition, an elevated SPI at the end of surgery was able to predict moderate-to-severe pain with a sensitivity of 0.71 (95% confidence interval (CI): 0.65–0.77; I2 = 29.01%) and a specificity of 0.58 (95% CI: 0.39–0.74; I2 = 79.31%). The overall accuracy based on the summary receiver operating characteristic (sROC) curve was 0.72. In conclusion, this meta-analysis highlighted the feasibility of the surgical pleth index to predict postoperative moderate-to-severe pain immediately after surgery. Our results from a limited number of studies warrant further investigations for verification.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City 71710, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70101, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi Mei Medical Center, Tainan City 71004, Taiwan
- Department of Medical Research, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan
| | - Ming Yew
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Ming-Chung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City 73657, Taiwan
- Correspondence: (I.-W.C.); (C.-K.S.)
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung City 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung City 84001, Taiwan
- Correspondence: (I.-W.C.); (C.-K.S.)
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