Ambulatory continuous posterior lumbar plexus blocks following hip arthroscopy: a review of 213 cases

Abstract

Study objective: To evaluate complications associated with ambulatory continuous lumbar plexus blocks.

Design: Retrospective review of all patients who received a continuous lumbar plexus block for analgesia following arthroscopic hip surgery from January 2004 to July 2009.

Setting: Academic medical center.

Measurements: Data from 213 patients who were discharged home with a continuous lumbar plexus block following hip arthroscopy were studied. Side effects and complications, including impaired ambulation, systemic local anesthetic toxicity, abnormal local anesthetic spread, and neurologic injury, were recorded.

Main results: Of the 281 patients who received a continuous lumbar plexus block following hip arthroscopy, 213 were discharged home with the continuous lumbar plexus block. Significant complications occurred in 3.8% of patients (8/213). Twenty of 213 patients (9.4%) reported prolonged sensory or motor deficits after the continuous lumbar plexus block was removed. Most of these deficits were minor and resolved spontaneously, but 4 patients (1.9%) experienced persistent neurologic symptoms. One patient had a fall, one patient was readmitted for possible bilateral spread from the continuous lumbar plexus block, and two patients experienced symptoms of local anesthetic systemic toxicity (LAST).

Conclusions: While complications associated with hip arthroscopy with ambulatory continuous lumbar plexus blocks do occur, significant complications are uncommon. Most complications are managed easily on an outpatient basis. However, nearly 1% of patients presented with symptoms concerning for LAST and were treated without any hemodynamic compromise.

Keywords: Continuous peripheral nerve block; Hip arthroscopy; Local anesthetic systemic toxicity; Lumbar plexus; Psoas compartment.