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49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting
March 21-23, 2024 | The Hilton Bayfront San Diego | San Diego, California
5352
NOVEL ANTERIOR LUMBAR PLEXUS VIA INGUINAL ENTRY (ALPINE) CATHETER FOR REPEAT HIP SURGERY IN A PATIENT WITH OPIOID USE DISORDER
Poster Presenter
Authors
Affiliations
Part of Topic
Medically Challenging Cases
Novel Anterior Lumbar Plexus via Inguinal Entry(ALPINE)catheterfor repeat hip surgery in a patient with opioid use disorder
Presenter: Nathan G Fritts, MD
Co-Author: Patrick R Hartmann, MD
BACKGROUND
•Regional techniques are helpful in hip fractures for reducing pain and opioid-related adverse effects.
•Compared to general anesthetic alone, lumbar plexus block reduces blood loss, opioid consumption and related complications; provides better analgesia than continuous femoral nerve blockade in total hip replacement.1,2
•Posterior approach is cumbersome for the patient and provider and carries significant risks.
CASE
•44 year old man with prior THA complicated by infection and s/p two antibiotic spacer revisions presented for revision arthroplasty.
•History of opioid use disorder now on buprenorphine-naloxone 8-2mg once daily, and trying to wean off completely.
•Past admissions complicated by difficult to control pain, required rescue lumbar plexus catheter following last hip surgery.
•Consented for continuous ALPINE catheter and GA.
•Catheter placed; proceeded with GA and received IV hydromorphone, dexmedetomidine, ketamine, and ketorolac.
POSTOPERATIVE COURSE
•0.2% ropivacaine at 6mL/hr infused via catheter with 3mL PCA bolus feature every 30 minutes until removal on postoperative day 3.
•Also received continuous IV ketamine infusion at 0.15mg/kg/hr until POD5 and multimodal regimen (acetaminophen, ketorolac, gabapentin, PRN oral hydromorphone).
•Discharged home POD6 with hydromorphone taper.
•Never required re-initiation of buprenorphine treatment during or after hospitalization.
DISCUSSION
•Combination of ALPINE catheter and multimodal analgesic regimen improved this patient’s pain course even with discontinuation of buprenorphine
•Lumbar plexus block may be superior for hip surgery, but single shot inguinal para-vascular techniques likely insufficient to reach lumbar plexus.3
•Correct placement of ALPINE catheters was verified with fluoroscopy in our early cases (Fig 2).
•ALPINE technique represents a novel and simplified US-guided approach to lumbar plexus block.
•Further research warranted to explore pain outcomes, length of stay, morbidity/mortality, etc.
REFERENCES:
2. J Bone Joint Surg Am 91 (1): 29-37