Influence of Lumbar Plexus Block for Proximal Modular Megaprostheses in Metastatic Bone Disease of the Femur

摘要

Background Modular megaprosthesis for proximal femur reconstruction after wide resection of metastatic lesion is a long-lasting painful procedure associated with prolonged hospital stay and significant blood loss. We evaluated the influence of lumbar plexus block on intraoperative and postoperative complications as well as length of hospital stay. Materials and Methods A retrospective study comparing two groups of patients for intraoperative and postoperative complications undergoing modular megaprosthesis for metastatic bone disease of the femur according to the type of anesthesia received. Group 1 included 20 patients undergoing the procedure under general anesthesia and group 2 had 19 patients undergoing the same procedure by the same surgeon under general anesthesia combined to lumbar plexus block. Results The two groups were comparable in terms of demographic characteristics and the primary location of the tumor except for smoking and lung cancer which were more frequent in group 1. Intraoperative variables were not statistically different between the two groups except for intraoperative blood loss ( P = 0.046) and transfusion ( P = 0.007). Respiratory complications were more frequent in the group 1 compared to group 2 (32% vs. 0%, P = 0.006) while there were no statistically significant difference for local complications, postoperative Hb and LOS. On multivariate analysis, NSAIDs consumption and general anesthesia were found to be and independent predictive factors for intraoperative blood loss. Age and ASA score were independent predictive factors for prolonged LOS. Smoking and lung cancer were predictive factors for respiratory complications. General anesthesia alone was not found to be a predictive risk factor for respiratory complications ( P = 0.245) and prolonged LOS ( P = 0.052). Conclusion Lumbar plexus block is an effective complement to general anaesthesia and intraoperative analgesic management of modular megaprosthesis for proximal femoral malignant lesions, reducing blood loss and transfusion during the surgical procedure. Prospective randomized trials are needed to confirm these findings.