Falls and major orthopaedic surgery with peripheral nerve blockade: A systematic review and meta-analysis

Department of Anesthesiology and.
BJA British Journal of Anaesthesia (Impact Factor: 4.85). 02/2013; 110(4). DOI: 10.1093/bja/aet013
Source: PubMed


The objective of this systematic review with meta-analysis was to determine the risk for falls after major orthopaedic surgery with peripheral nerve blockade. Electronic databases from inception through January 2012 were searched. Eligible studies evaluated falls after peripheral nerve blockade in adult patients undergoing major lower extremity orthopaedic surgery. Independent reviewers working in duplicate extracted study characteristics, validity, and outcomes data. The Peto odds ratio (OR) with 95% confidence intervals (CIs) were estimated from each study that compared continuous lumbar plexus blockade with non-continuous blockade or no blockade using a fixed effects model. Ten studies (4014 patients) evaluated the number of falls as an outcome. Five studies did not contain comparison groups. The meta-analysis of five studies [four randomized controlled trials (RCTs) and one cohort] compared continuous lumbar plexus blockade (631 patients) with non-continuous blockade or no blockade (964 patients). Fourteen falls occurred in the continuous lumbar plexus block group when compared with five falls within the non-continuous block or no block group (attributable risk 1.7%; number needed to harm 59). Continuous lumbar plexus blockade was associated with a statistically significant increase in the risk for falls [Peto OR 3.85; 95% CI (1.52, 9.72); P=0.005; I2=0%]. Evidence was low (cohort) to high (RCTs) quality. Continuous lumbar plexus blockade in adult patients undergoing major lower extremity orthopaedic surgery increases the risk for postoperative falls compared with non-continuous blockade or no blockade. However, attributable risk was not outside the expected probability of postoperative falls after orthopaedic surgery. © 2013 © The Author [2013]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected]
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Available from: James R Hebl, Jan 04, 2016
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    • "In addition, various multimodal analgesic options have been developed and their different combinations are currently used in clinical practice [7] [8]: paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, ketamine [9], alpha-2 adrenergic agonists [10], corticosteroids [11], gabapentinoids, local infiltration analgesia (LIA), prolonged epidural anesthesia, continuous or single-shot peripheral nerve blocks, and cryotherapy. All of these options have established advantages and disadvantages both from clinical and economical points of view [12] [13], but consensus on what protocols are most beneficial among different patient subgroups is still lacking [14]. Despite the fact that modern multimodal approaches to analgesia have decreased the prevalence of persistent postsurgical pain after TKA, further improvement is necessary. "
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