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The Effect of Regional Analgesia on Vascular Tone in Hip Arthroplasty Patients



While it is assumed that neuraxial analgesia and pain management may beneficially influence perioperative hemodynamics, few studies provided data quantifying such effects and none have assessed the potential contribution of the addition of a nerve block.


This clinical trial compared the visual analog scale (VAS) scores and measurement of arterial tone using augmentation index of patients who received combined spinal–epidural (CSE) only to patients who received both CSE and lumbar plexus block.


After obtaining written consent, 92 patients undergoing total hip arthroplasty were randomized to receive either CSE or CSE with lumbar plexus block (LPB). Perioperative pain and arterial tone were measured using VAS scores and augmentation index (AI) respectively, at baseline and at various times postoperatively.


After the exclusion of 2 patients, 44 patients received CSE alone and 46 patients received CSE and LPB. Patient demographics and perioperative characteristics were similar in both groups. AI continuously decreased after placement of a CSE with or without LBP, beyond full resolution of neuraxial and peripheral blockade. Although the LPB group demonstrated a statistically significant reduction of VAS pain scores in the postanesthesia care unit (PACU; P < 0.05), overall, the addition of a LPB did not significantly reduce the AI when compared to the control group.


The addition of a LPB provided better pain control in the PACU but did not reduce the AI, compared to the control group. We conclude that the addition of a LPB may have limited ability to affect arterial tone in the presence of a continuous infusion of epidural analgesics. In summary, the addition of a LPB in patients undergoing total hip arthroplasty is clinically effective and provided better pain control, especially in the immediate postoperative period. The continuous decrease on the AI in both groups beyond the full resolution of the neuroaxial and LPB will require further studies.

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We thank Ms. Tara Thompson, RN, BN, for her help with late-night follow-up examinations.

Compliance with Ethical Standards

Conflict of Interest

Enrique A. Goytizolo, MD, Ottokar Stundner, MD, Sandra Hurtado Rúa, PhD, Dorothy Marcello, BA, Valeria Buschiazzo, Ansara M Vaz, MD and Stavros G Memtsoudis, MD, PhD have declared that they have no conflict of interest.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.


This study was supported with funds from the Research and Education Fund of the Department of Anesthesiology at the Hospital for Special Surgery. Dr. Sandra Hurtado Rúa was partially supported by the following grant: Clinical Translational Science Center (CTSC) (UL1- RR024996).

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Correspondence to Enrique A. Goytizolo MD.

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Level of Evidence: Therapeutic study, level II.

Work performed at Hospital for Special Surgery.

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Goytizolo, E.A., Stundner, O., Rúa, S.H. et al. The Effect of Regional Analgesia on Vascular Tone in Hip Arthroplasty Patients. HSS Jrnl 12, 125–131 (2016).

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  • hip arthroplasty
  • arterial stiffness
  • vascular resistance
  • lumbar plexus block