Continuous L2 ParavertebraL bLoCk for PostoPerative anaLgesia after DireCt anterior totaL HiP artHroPLasty: a Case series

Objective: the purpose of this case series was to assess the potential use of a continuous paravertebral block (Pvb) at the L2 nerve root level as a part of a multimodal regimen in patients undergoing direct anterior total hip arthroplasty (Da-tHa). Design: 20-patient case series. Setting: tertiary care hospital. Subjects: patients undergoing Da-tHa. Methods: We retrospectively analyzed 20 patients undergoing Da-tHa who had a continuous L2 PVB until postoperative day 2. Hip flexor strength, pain scores, opioid use, and length of stay were assessed post operatively. Results: 11 of 20 patients had motor weakness to gravity postoperatively. However, mean basic mobility score on postoperative day (POD) 1 was 18.4 ± 2.4. Mean maximum pain on POD0 was 5.4 ± 3.0. On POD1, mean dynamic and maximum pain scores were 3.5 ± 2.5 and 3.5 ± 2.8, respectively. Mean intravenous morphine use was 22.5mg ± 13.4 and 16.5mg ± 11.4 on PoD0 and POD1, respectively. Mean discharge day was 2.1 ± 0.5. Conclusions: While over half of the patients in our case series had some hip weakness postoperatively, participation in physical therapy was not hindered. An L2 PVB catheter, combined with a multimodal postoperative pain control regimen, may provide analgesia after anteriorapproach tHa without inhibiting recovery.