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Tulgar S, Ciftci B, Ahiskalioglu A, Bilal B, Sakul BU, Girit M, Akin T, Narayanan M, Alici HA. Ultrasound guided quadro-iliac plane block: another novel fascial plane block. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:370-373. [PMID: 38459608 DOI: 10.1093/pm/pnae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/09/2024] [Indexed: 03/10/2024]
Abstract
STUDY OBJECTIVE We report a novel block technique aimed to provide lumbosacral, abdominal, and hip analgesia: The quadro-iliac plane (QIP) block. DESIGN A cadaveric examination that evaluates the spread of QIP block. SETTING Cadaver laboratory. PATIENTS One unembalmed cadaver. INTERVENTIONS Bilateral ultrasound-guided QIP blocks on cadavers with 40 mL of methylene blue %0.5 each side. MEASUREMENTS Dye spread in cadaver. MAIN RESULTS There was staining in the deep interfascial plane of the erector spinae muscles. Extensive staining of the interfascial plane corresponding to the posterior aspect of the quadratus lumborum muscle (QLM) was observed. There was extensive staining on the anterior surface of the QLM. There was spread of dye traversing along the transversalis fascia and significantly infiltrating retroperitoneal fat tissue. Bilateral staining of the ilioinguinal and iliohypogastric nerves was observed. On the right, there was minimal staining over the subcostal nerve. There was dye present bilaterally within the deep regions of the transverse processes. The lumbar plexus was stained on both sides. CONCLUSION The local anesthetic applied from a place where the QLM reaches its largest volume and the fascial plane creates a closed gap in the caudal area may exhibit a more rounded and extensive spread.Quadro-iliac plane block, involves the administration of local anesthetic to the posterior aspect of the QLM at its origin from the iliac crest. According to our cadaver study, this technique may be a promising option for alleviating acute and chronic pain in the lumbosacral, lower abdominal, and hip regions.
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Affiliation(s)
- Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, 55020, Turkey
| | - Bahadir Ciftci
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, 34000, Turkey
- Department of Anatomy, Istanbul Medipol University, Istanbul, 34000, Turkey
| | - Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, 25030, Turkey
| | - Bora Bilal
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Kahramanmaras Sutcu Imam University, Kahramanmaras, 46000, Turkey
| | - Bayram Ufuk Sakul
- Department of Anatomy, Istanbul Medipol University, Istanbul, 34000, Turkey
| | - Melike Girit
- Department of Anatomy, Istanbul Medipol University, Istanbul, 34000, Turkey
| | - Tugce Akin
- Department of Anatomy, Istanbul Medipol University, Istanbul, 34000, Turkey
| | - Madan Narayanan
- Consultant-Anaesthetics and Intensive Care, Frimley Park Hospital NHS Foundation Trust, Camberley, GU14 8HT, United Kingdom
| | - Haci Ahmet Alici
- Department of Pain Medicine, Istanbul Medipol University, Istanbul, 34000, Turkey
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Braun AS, Peabody Lever JE, Kalagara H, Piennette PD, Arumugam S, Mabry S, Thurston K, Naranje S, Feinstein J, Kukreja P. Comparison of Pericapsular Nerve Group (PENG) Block Versus Quadratus Lumborum (QL) Block for Analgesia After Primary Total Hip Arthroplasty Under Spinal Anesthesia: A Retrospective Study. Cureus 2023; 15:e50119. [PMID: 38192933 PMCID: PMC10771930 DOI: 10.7759/cureus.50119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is one of the most common operative procedures performed. Controlling postoperative pain following THA remains a challenge due to the complex innervation of the hip joint and the recent desire to preserve motor function following nerve blockade. Several nerve block techniques have been used for THA in the past, but the quadratus lumborum (QL) block and the blockade of the pericapsular nerve group (PENG) have emerged as opiate-sparing regional anesthesia techniques that preserve motor function. To date, little data comparing the two block techniques exists. The purpose of our study was to compare outcomes following these techniques in patients undergoing primary THA. MATERIALS AND METHODS This retrospective analysis utilized data from three distinct groups who underwent primary THA at our institution: 45 patients who received PENG block, 38 patients who received QL block, and 77 control patients. Chart review analysis was performed by authorized personnel to obtain cumulative oral morphine equivalent (OME) data at 24 and 48 hours postoperatively (primary outcomes). In addition, visual analog pain scale (VAS) scores in the post-anesthesia care unit (PACU) and at 12, 24, and 48 hours, ambulation distance, and length of hospital stay data were obtained (secondary outcomes). Group comparisons were conducted using either analysis of variance (ANOVA) with Tukey's multiple comparison test for parametric data or Krustal-Wallis with Dunn's multiple comparison tests for nonparametric endpoints. RESULTS This study found a statistically significant difference in cumulative OME usage across all groups at 24 and 48 hours. Significant difference in OMEs was found between QL and control and PENG and control; however, no difference was found in OMEs between PENG and QL groups at either time point. There was a statistically significant difference in VAS scores in the PACU across all groups; QL showed significantly lower VAS scores in the PACU compared to PENG and control, while PENG only showed significantly lower VAS scores compared to control. There was a statistically significant difference in VAS scores at 24 hours across all groups; however, only QL showed significantly lower VAS scores compared to control at 24 hours. QL was associated with a statistically significant increase in the length of hospital stay compared to PENG. CONCLUSION This study showed no difference between OME usage in patients who received PENG or QL nerve blocks for primary THA. VAS scores were similar between groups with the exception of QL outperforming PENG in the PACU. Optimizing postoperative pain via multi-approach strategies should remain a priority for patients undergoing THA. Future research is warranted in order to provide guidance on best practice for these patients.
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Affiliation(s)
- Andrew S Braun
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Jacelyn E Peabody Lever
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
- Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, USA
| | - Paul D Piennette
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Sivasenthil Arumugam
- Anesthesiology, University of Connecticut School of Medicine, Farmington, USA
- Anesthesiology, Saint Francis Hospital and Medical Center / University of Connecticut, Hartford, USA
| | - Scott Mabry
- Orthopaedics, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Kesha Thurston
- Anesthesiology, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Sameer Naranje
- Orthopaedics, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Joel Feinstein
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Promil Kukreja
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
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Wang X, Zhang H, Chen Y, Xie Z, Chen M, Chen Y, Zhang J. The anesthetic efficacy of ultrasound-guided lumbar plexus combined with quadratus lumborum block with Shamrock approach in total hip arthroplasty: study protocol for a randomized controlled trial. Trials 2023; 24:596. [PMID: 37718446 PMCID: PMC10506336 DOI: 10.1186/s13063-023-07619-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION The lumbar plexus originates from multiple segments of the spinal cord. Both single-level lumbar plexus block (LPB) and transmuscular quadratus lumborum block (TQLB) are commonly used to provide analgesia for the patients undergoing total hip arthroplasty (THA). However, neither of them can completely cover the lumbar plexus. Multiple-level LPB is also not recommended since this expert technique involves more potential risks. To achieve a better anesthetic effect and avoid risks, we propose to combine ultrasound-guided LPB with TQLB with Shamrock approach. We aim to assess the anesthetic efficacy of this combination technique and expect it will be an ideal alternative for conventional LPBs in THA. METHODS AND ANALYSIS In this prospective randomized controlled trial, 84 patients schedule for THA will be enrolled. The patients will be randomly assigned at a 1:1:1 ratio to receive LPB at L3 level (P group), T12 paravertebral block combined with LPB at L3 and L4 levels (TP group), or LPB combined with TQLB at L3 level (PQ group). Each method will be evaluated in terms of the successful rate of sensory blockade, postoperative pain, performance time of block, requirement for intraoperative sufentanil, cumulative doses of intraoperative vasoactive medications, and adverse events. ETHICS AND DISSEMINATION The study protocol has been approved by the institutional review board (IRB) at Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China (No.2020-031). The results will be disseminated in a peer-reviewed journal and the ClinicalTrials.gov registry. TRIAL REGISTRATION ClinicalTrials.gov, NCT04266236 . Registered on 10 February 2020. CLINICALTRIALS gov PRS: Record Summary NCT04266236 .
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Affiliation(s)
- Xiaofeng Wang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Hui Zhang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Yongzhu Chen
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Zhenwei Xie
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Moxi Chen
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Yonglin Chen
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Junfeng Zhang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China.
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Wu J, Qin Y, She H, Ma R. Review of the injectate dispersion pattern during anterior quadratus lumborum block. Medicine (Baltimore) 2022; 101:e32038. [PMID: 36482577 PMCID: PMC9726280 DOI: 10.1097/md.0000000000032038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Since its introduction in 2013, the anterior quadratus lumborum (QL) block (QLB) has been widely used for analgesia in abdominal, pelvic, and hip surgeries, based on the assumption that it has analgesic effects on both incisional and visceral pain. However, the mechanism of the anterior QLB remains unclear, and the results of relevant studies are contradictory. This review aimed to summarize the dispersion patterns of injectates in anterior QLB. We conducted literature searches using PubMed, Cochrane, and Embase databases. A total of 10 cadaveric or radiological studies meeting the inclusion and exclusion criteria were summarized. The dye or contrast agent spread to the thoracic paravertebral space in only 5 of the studies reviewed. Variability in the selection of injection sites relative to the anterior layer of the thoracolumbar fascia during anterior QLB implementation may explain the dispersion difference. The correct injection site of an anterior QLB is anterior to the QL muscle and between the QL muscle and the anterior layer of the thoracolumbar fascia. Further studies are needed to verify the injectate dispersion pattern during anterior QLB.
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Affiliation(s)
- Jin Wu
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang City, Jiangsu Province, China
| | - Yifan Qin
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang City, Jiangsu Province, China
| | - Huiyu She
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang City, Jiangsu Province, China
| | - Rui Ma
- Department of Human Anatomy, Medical School, Jiangsu University, Zhenjiang City, Jiangsu Province, China
- * Correspondence: Rui Ma, Department of Human Anatomy, Medical School, Jiangsu University, 301 Xuefu Road, Zhenjiang City, Jiangsu Province 212013, China (e-mail: )
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5
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Shao L, Luo X, Ye Y, Liu L, Cai Y, Xia Y, Papadimos TJ, Wang Q, Pan L. Anterior Quadratus Lumborum block area comparison in the three different volumes of Ropivacaine: a double-blind, randomized controlled trial in healthy volunteers. BMC Anesthesiol 2022; 22:365. [PMID: 36447137 PMCID: PMC9706850 DOI: 10.1186/s12871-022-01922-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In abdominal surgery, ultrasound-guided anterior quadratus lumborum blocks (QLB) are performed to induce analgesia. However, no study reported suitable volumes of the anterior QLB for the different postoperative analgesia regions. Therefore, this prospective randomized controlled study assessed the dermatomal spread and analgesic effects of the three different volumes of a local anesthetic for anterior QLB. METHODS Ultrasound-guided anterior QLB was performed at the L2 level on 30 healthy volunteers. The volunteers were randomized to receive 20 ml (n = 10), 30 ml (n = 10), and 40 mL (n = 10) of 0.375% ropivacaine. The cutaneous sensory blocked area (CSBA), the number of block dermatomes, and the block duration time were measured by determining the extent of the cold sensation. RESULTS The CSBA was significantly larger in the 40 ml group than in the 30 (P = 0.001; 1350.6 ± 234.4 vs. 1009.5 ± 151.6 cm2) and 20 ml groups (P < 0.001; 1350.6 ± 234.4 vs. 808.1 ± 120.5 cm2). Similarly, the number of blocked dermatomes was significantly higher in the 40 ml group than in the 30- and 20-ml groups. However, no significant difference was observed in block duration among the groups. CONCLUSIONS No difference was observed in block duration with the various volumes of 0.375% ropivacaine. However, the larger volume for anterior QLB contributed to a larger area of cutaneous sensory blockade. Appropriate volumes in anterior QLB can create suitable postoperative analgesia levels for the different operative sites. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registration Center on www.chictr.org.cn on 27th April 2018 (registration number: ChiCTR-IOR-17010853).
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Affiliation(s)
- Liang Shao
- Department of Anesthesiology, the People’s Hospital of Yuhuan, Taizhou City, 317600 Zhejiang Province China ,grid.268099.c0000 0001 0348 3990Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
| | - Xu Luo
- grid.268099.c0000 0001 0348 3990Department of Burn, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
| | - Yingchao Ye
- grid.268099.c0000 0001 0348 3990Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
| | - Le Liu
- grid.268099.c0000 0001 0348 3990Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
| | - Yaoyao Cai
- grid.268099.c0000 0001 0348 3990Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
| | - Yun Xia
- grid.412332.50000 0001 1545 0811Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Thomas J. Papadimos
- grid.412332.50000 0001 1545 0811Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Quanguang Wang
- grid.268099.c0000 0001 0348 3990Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
| | - Linmin Pan
- grid.268099.c0000 0001 0348 3990Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
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Shi R, Wang M, Yang X, Shao P, Liang J, Wang Y. Evaluation of Sensory Loss and Postoperative Analgesia Obtained by Diaphragmatic Apposition Zone Block Under Direct Laparoscopic Visualization in Patients Undergoing Nephrectomy: A Descriptive Study. J Pain Res 2022; 15:2015-2023. [PMID: 35910090 PMCID: PMC9331804 DOI: 10.2147/jpr.s371140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Local anesthetics can spread into the subendothoracic fascia compartment via the arcuate ligament and apposition zone of the diaphragm after the anterior quadratus lumborum blocks. Therefore, a new block may be achieved if local anesthetic is administered into the diaphragmatic apposition zone (DAZ) under direct laparoscopic visualization by surgeons. Therefore, we evaluated the sensory loss and postoperative analgesic efficacy of this new block in patients receiving laparoscopic nephrectomy. Methods A total of 28 patients scheduled to receive elective laparoscopic nephrectomy under general anesthesia were enrolled in this study. The DAZ blocks were performed in patients under direct laparoscopic visualization with 20 mL of 0.5% ropivacaine before the dissected kidneys or renal tumors were taken out from the incision. All patients received the intravenous patient-controlled analgesia after surgery. The dermatomes of sensory loss and the muscle weakness of quadriceps femoris were assessed at 2 h post-surgery in the wards. The postoperative pain was scored. The opioid consumption in the first 24 h after surgery was recorded. Results The average number of dermatomes of sensory block was 8.6 ± 1.2. The highest level of sensory loss was T6 (T5-T6) [median (interquartile range, IQR)], and the lowest level of sensory block was L1 (L1–L2). The postoperative pain scores at rest or on movement at 2 h, 6 h, 12 h, 24 h and 48 h were kept at the low levels (less than 4). The muscle strength of the quadriceps femoris evaluated was 5 (5–5) points [median (IQR)]. Total dose of intravenous morphine equivalent consumption in the first 24 h after surgery was 21.2 ± 4.1 mg. Conclusion The DAZ block manifests a wide dermatomal coverage of sensory loss and is associated with the low levels of postoperative pain intensity and opioid use. It provides a new postoperative analgesia option for patients undergoing laparoscopic nephrectomy.
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Affiliation(s)
- Rong Shi
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Mingshuai Wang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Xiaoyong Yang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Peiqi Shao
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Jinghan Liang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Yun Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
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Ultrasound-Guided Quadratus Lumborum Block Enhances the Quality of Recovery after Gastrointestinal Surgery: A Randomized Controlled Trial. Pain Res Manag 2022; 2022:8994297. [PMID: 35535242 PMCID: PMC9078840 DOI: 10.1155/2022/8994297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/08/2022] [Indexed: 11/24/2022]
Abstract
Background Quadratus lumborum block (QLB) has been used to reduce postoperative acute pain and opioid consumption. However, the efficacy of QLB on the quality of recovery (QoR) after gastrointestinal surgery has not been established. The aim of this study was to evaluate the ability of QLB to enhance the postoperative QoR in patients undergoing open gastrointestinal surgery. Methods Eighty-four patients undergoing open gastrointestinal surgery were randomized to receive ultrasound-guided QLB with either 20 ml of 0.375% ropivacaine or saline. The primary outcome was the QoR-15 score at 24 h after surgery. The secondary outcomes were the postoperative pain intensity, opioid consumption, the incidence of nausea, vomiting, and chronic pain. Results The global QoR-15 score at 24 h postoperatively was significantly higher in the QLB group than in the control group (mean difference: 16.9; 95% CI: 11.9–21.9). Additionally, the QoR-15 scores for five dimensions were significantly higher in the QLB group than in the control group. The cumulative oxycodone consumption was significantly lower in the QLB group during 0–6, 6–24, 0–24, 24–48, and 0–48 h postoperatively than in the control group. At rest or during coughing, the pain verbal rating scale scores were significantly lower at 1, 3, 6, 12, and 24 h after surgery in the QLB group than in the control group. The incidence of postoperative nausea was significantly different between the groups, but postoperative vomiting was not. Conclusion Single-injection posteromedial QLB with ropivacaine enhanced the QoR at 48 h after surgery and improved analgesia during the early postoperative period in patients undergoing gastrointestinal surgery.
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El-Boghdadly K, Wolmarans M, Stengel AD, Albrecht E, Chin KJ, Elsharkawy H, Kopp S, Mariano ER, Xu JL, Adhikary S, Altıparmak B, Barrington MJ, Bloc S, Blanco R, Boretsky K, Børglum J, Breebaart M, Burckett-St Laurent D, Capdevila X, Carvalho B, Chuan A, Coppens S, Costache I, Dam M, Egeler C, Fajardo M, Gadsden J, Gautier PE, Grant SA, Hadzic A, Hebbard P, Hernandez N, Hogg R, Holtz M, Johnson RL, Karmakar MK, Kessler P, Kwofie K, Lobo C, Ludwin D, MacFarlane A, McDonnell J, McLeod G, Merjavy P, Moran E, O'Donnell BD, Parras T, Pawa A, Perlas A, Rojas Gomez MF, Sala-Blanch X, Saporito A, Sinha SK, Soffin EM, Thottungal A, Tsui BCH, Tulgar S, Turbitt L, Uppal V, van Geffen GJ, Volk T, Elkassabany NM. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks. Reg Anesth Pain Med 2021; 46:571-580. [PMID: 34145070 DOI: 10.1136/rapm-2020-102451] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques. METHODS We conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement. RESULTS Sixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified. CONCLUSIONS Harmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice.
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Affiliation(s)
- Kariem El-Boghdadly
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human & Applied Physiological Sciences, King's College London, London, UK
| | - Morné Wolmarans
- Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
| | - Angela D Stengel
- American Society of Regional Anesthesia and Pain Medicine, Pittsburgh, Pennsylvania, USA
| | - Eric Albrecht
- Department of Anaesthesia, University of Lausanne, Lausanne, Switzerland
| | - Ki Jinn Chin
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Hesham Elsharkawy
- Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA.,Case Western Reserve University, Cleveland, Ohio, USA
| | - Sandra Kopp
- Anesthesiology, Mayo Clinic Graduate School for Biomedical Sciences, Rochester, Minnesota, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jeff L Xu
- Anesthesiology, Westchester Medical Center, Valhalla, New York, USA.,New York Medical College, Valhalla, New York, USA
| | - Sanjib Adhikary
- Anesthesiology and Perioperative Medicine, Penn State, University Park, Pennsylvania, USA
| | | | | | - Sébastien Bloc
- Anesthesiology Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, Île-de-France, France.,Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, Île-de-France, France
| | - Rafael Blanco
- Anaesthesia and Intensive Care, King's College Hospital Dubai, Abu Dhabi, UAE
| | - Karen Boretsky
- Anesthesiology, Critical Care and Pain Medicine, Harvard University, Cambridge, Massachusetts, USA
| | - Jens Børglum
- Department of Anesthesiology, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
| | | | | | - Xavier Capdevila
- Anesthesiology and Critical Care department, Hôpital Lapeyronie, Montpellier, Languedoc-Roussillon, France
| | | | - Alwin Chuan
- University of New South Wales Faculty of Medicine, Putney, New South Wales, Australia
| | | | - Ioana Costache
- Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Mette Dam
- Anaesthesiology, Zealand University Hospital Koge, Koge, Sjælland, Denmark
| | | | - Mario Fajardo
- Anesthesiology, Hospital Universitario de Mostoles, Mostoles, Madrid, Spain
| | - Jeff Gadsden
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Stuart Alan Grant
- Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Admir Hadzic
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium.,NYSORA, New York, New York, USA
| | - Peter Hebbard
- Department of Anesthesia Northeast Health Wangaratta, Ultrasound Education Group, The University of Melbourne Rural Health Academic Centre - Wangaratta, Wangaratta, Victoria, Australia
| | - Nadia Hernandez
- Anesthesiology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Rosemary Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Rebecca L Johnson
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Manoj Kumar Karmakar
- Department of Anesthesia and Intensice Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Paul Kessler
- Anesthesiology, Intensive Care and Pain Medicine, Universitätsklinikum Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Kwesi Kwofie
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Clara Lobo
- Anestesiologia, Hospital das Forças Armadas Polo do Porto, Porto, Portugal
| | | | - Alan MacFarlane
- Department of Cardiology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Graeme McLeod
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK.,Instittute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | | | - Eml Moran
- Letterkenny University Hospital, Letterkenny, Donegal, Ireland
| | - Brian D O'Donnell
- Department of Anesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland
| | | | - Amit Pawa
- Department of Anaesthesia, St Thomas' Hospital, London, UK.,Regional Anaesthesia - UK, London, UK
| | - Anahi Perlas
- Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Xavier Sala-Blanch
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain.,Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Andrea Saporito
- Anesthesia, Ospedale Regionale di Bellinzona e Valli Bellinzona, Bellinzona, Switzerland
| | - Sanjay Kumar Sinha
- Anesthesiology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | | | - Ban C H Tsui
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Serkan Tulgar
- Anesthesiology and reanimatiom, Maltepe Universitesi Tip Fakultesi, Maltepe, Turkey
| | - Lloyd Turbitt
- Royal Victoria Hospital Laboratory and Mortuary Services, Belfast, UK
| | - Vishal Uppal
- Anesthesia, Dalhousie University - Faculty of Health Professions, Halifax, Nova Scotia, Canada
| | - Geert J van Geffen
- Anesthesiology, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany.,Saarland University, Saarbrucken, Saarland, Germany
| | - Nabil M Elkassabany
- Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,University of Pennsylvania, Philadelphia, Pennsylvania, USA
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9
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Kim DH, Kim SJ, Liu J, Beathe J, Memtsoudis SG. Fascial plane blocks: a narrative review of the literature. Reg Anesth Pain Med 2021; 46:600-617. [PMID: 34145072 DOI: 10.1136/rapm-2020-101909] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/16/2022]
Abstract
Fascial plane blocks (FPBs) are increasingly numerous and are often touted as effective solutions to many perioperative challenges facing anesthesiologists. As 'new' FPBs are being described, questions regarding their effectiveness remain unanswered as appropriate studies are lacking and publications are often limited to case discussions or technical reports. It is often unclear if newly named FPBs truly represent a novel intervention with new indications, or if these new publications describe mere ultrasound facilitated modifications of existing techniques. Here, we present broad concepts and potential mechanisms of FPB. In addition, we discuss major FPBs of (1) the extremities (2) the posterior torso and (3) the anterior torso. The characteristics, indications and a brief summary of the literature on these blocks is included. Finally, we provide an estimate of the overall level of evidence currently supporting individual approaches as FPBs continue to rapidly evolve.
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Affiliation(s)
- David H Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Sang Jo Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jiabin Liu
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jonathan Beathe
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Stavros G Memtsoudis
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA .,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
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10
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Xia Q, Ding W, Lin C, Xia J, Xu Y, Jia M. Postoperative pain treatment with transmuscular quadratus lumborum block and fascia iliaca compartment block in patients undergoing total hip arthroplasty: a randomized controlled trial. BMC Anesthesiol 2021; 21:188. [PMID: 34243719 PMCID: PMC8272275 DOI: 10.1186/s12871-021-01413-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background Patients often suffer moderate or even severe pain after total hip arthroplasty; such pain seriously affects early postoperative recovery. This study aimed to investigate the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block combined with fascia iliaca compartment block for elderly patients undergoing total hip arthroplasty. Methods Fifty-four patients scheduled for total hip arthroplasty were included in this randomized controlled study. The patients were randomly assigned to receive only transmuscular quadratus lumborum block (group Q) or transmuscular quadratus lumborum block combined with fascia iliaca compartment block (group QF) with ultrasound guidance. Postoperatively in both groups, paracetamol 1 g was regularly administered at 6 h intervals and patient-controlled intravenous analgesia was administered. The primary outcome was cumulative sufentanil consumption via patient-controlled intravenous analgesia 24 h postoperatively. The secondary outcomes included pain degree, time to the first analgesic requirement, joint range of motion, quality of recovery, and the incidence of postoperative complications. Results Fifty patients were included, and their data were analyzed. The cumulative sufentanil consumption in group QF was significantly lower during the first 24 h after surgery than that in group Q, and the cumulative sufentanil consumption in group QF was reduced at 6–12 and 12–18 h after surgery. The postoperative pain intensity was lower in group QF than in group Q (linear mixed-effects model, the main effect of treatment: P < 0.001). Compared with group Q, group QF had higher quality of recovery and joint range of movement. The time to the first analgesic requirement was longer in group QF than in group Q (log-rank, P < 0.001). There was no statistically significant difference in complications postoperatively between the two groups. Conclusions Our study provides a multimodal, opioid-sparing analgesic regimen for elderly patients undergoing total hip arthroplasty. The combination of transmuscular quadratus lumborum block and fascia iliaca compartment block provides a significant advantage for early postoperative functional recovery. Further studies are required to confirm the minimum effective dose. Trial registration The study was registered on the 21st December 2020 (retrospectively registered) on the Chinese Clinical Trial Registry: ChiCTR2000038686.
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Affiliation(s)
- Qin Xia
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, No.99, Huaihai West Road, Quanshan District, Jiangsu Province, 221000, China
| | - Wenping Ding
- Department of Anesthesiology, Xuzhou Central Hospital, 199 Jiefang South Road, Quanshan District, Jiangsu Province, 221000, China
| | - Chao Lin
- Department of Anesthesiology, Xinhua Hospital, Shanghai Jiaotong University, 1665 Kongjiang Road, Yangpu District, Shanghai, 200082, China
| | - Jiayi Xia
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, No.99, Huaihai West Road, Quanshan District, Jiangsu Province, 221000, China
| | - Yahui Xu
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, No.99, Huaihai West Road, Quanshan District, Jiangsu Province, 221000, China
| | - Mengxing Jia
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, No.99, Huaihai West Road, Quanshan District, Jiangsu Province, 221000, China.
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11
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Nassar H, Hasanin A, Sewilam M, Ahmed H, Abo-Elsoud M, Taalab O, Rady A, Zoheir HA. Transmuscular Quadratus Lumborum Block versus Suprainguinal Fascia Iliaca Block for Hip Arthroplasty: A Randomized, Controlled Pilot Study. Local Reg Anesth 2021; 14:67-74. [PMID: 33907462 PMCID: PMC8068517 DOI: 10.2147/lra.s308964] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/24/2021] [Indexed: 01/05/2023] Open
Abstract
Background This study aimed to investigate the analgesic efficacy and motor block profile of single-shot transmuscular quadratus lumborum block (QLB) in comparison with those of suprainguinal fascia iliaca block (FIB) in patients undergoing hip arthroplasty. Methods This randomized, double-blinded, controlled trial included adult patients undergoing hip arthroplasty under spinal anesthesia. Patients were allocated to one of two groups according to the regional block received: FIB group (n=19) or QLB group (n=17). Both study groups were compared with regard to the duration of analgesia (primary outcome), block performance time, pain during positioning for spinal anesthesia, total morphine consumption in the first postoperative 24-h period, quadriceps muscle power, and static and dynamic visual analog scale. Results Thirty-six patients were included in the final analysis. Both study groups had comparable durations of analgesia. Postoperative visual analog scale (static and dynamic) values were comparable between the two groups in most readings. The block performance time was shorter in the FIB group. The number of patients with pain during positioning for the subarachnoid block was lower in the QLB group. The total morphine requirement during the first 24 h was marginally lower in the FIB group, whereas the quadriceps motor grade was higher in the FIB group than in the QLB group at 4 h and 6 h after surgery. Conclusion Both single-shot blocks, namely the suprainguinal FIB and transmuscular QLB, provide effective postoperative analgesia after hip arthroplasty. FIB showed slightly lower 24-h morphine consumption, while QLB showed better quadriceps motor power. Clinical Trial Registration The study was registered at clinical trials registry system before enrollment of the first participant (NCT04005326; initial release date, 2 July 2019; https://clinicaltrials.gov/ct2/show/NCT04005326).
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Affiliation(s)
- Heba Nassar
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Sewilam
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Ahmed
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Omar Taalab
- Department of Orthopedic Surgery, Cairo University, Cairo, Egypt
| | - Ashraf Rady
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Allah Zoheir
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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12
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Kukreja P, Schuster B, Northern T, Sipe S, Naranje S, Kalagara H. Pericapsular Nerve Group (PENG) Block in Combination With the Quadratus Lumborum Block Analgesia for Revision Total Hip Arthroplasty: A Retrospective Case Series. Cureus 2020; 12:e12233. [PMID: 33500856 PMCID: PMC7819427 DOI: 10.7759/cureus.12233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2020] [Indexed: 11/29/2022] Open
Abstract
Orthopedic procedures involving the hip have remained challenging for regional anesthesia given the complex innervation, painful nature contributing to difficulty positioning, and a desire to maintain mobility to hasten postoperative recovery. The revision total hip arthroplasty (THA) poses a greater challenge for an effective regional analgesia due to complex surgical approach, scarring from previous surgery and limited patient mobility. The quadratus lumborum (QL) block has demonstrated to provide effective analgesia for primary hip surgery in recent studies. The pericapsular nerve group (PENG) block has also shown to provide analgesia in patients with hip fractures. There is no standard of care regional anesthesia technique for hip surgeries, and the regional practice varies widely among anesthesia providers. This retrospective case series studied the effect of combining the QL with PENG block on the revision THA analgesia.
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Affiliation(s)
- Promil Kukreja
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Braden Schuster
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Theresa Northern
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Sandra Sipe
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Sameer Naranje
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Hari Kalagara
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
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13
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Pascarella G, Costa F, Strumia A, Agrò FE, Del Buono R. The multiple pathways of local anaesthetic during lumbar erector spinae plane block: an ultrasound finding. Anaesthesia 2020; 76:142-143. [PMID: 33155671 DOI: 10.1111/anae.15216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 01/19/2023]
Affiliation(s)
- G Pascarella
- Università Campus Bio-Medico di Roma, Rome, Italy
| | - F Costa
- Università Campus Bio-Medico di Roma, Rome, Italy
| | - A Strumia
- Università Campus Bio-Medico di Roma, Rome, Italy
| | - F E Agrò
- Università Campus Bio-Medico di Roma, Rome, Italy
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14
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The effectiveness of the intramuscular quadratus lumborum block in postoperative analgesia after cesarean section with vertical incision: a randomized, double-blinded placebo-controlled study. J Anesth 2020; 34:849-856. [PMID: 32691228 DOI: 10.1007/s00540-020-02829-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/13/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE Quadratus lumborum block (QLB) has recently been used for postoperative analgesia after abdominal surgery. Although there are several approaches to QLB, the effectiveness of intramuscular QLB (QLBi) remains controversial. The aim of the present study was to examine the effectiveness of QLBi for postoperative analgesia after cesarean section with a vertical midline incision. METHODS In this single-center, randomized, double-blinded placebo-controlled study, 36 women who were scheduled for elective cesarean section were randomly divided into a QLBi group (n = 18) and a placebo group (n = 18). In both groups, spinal anesthesia was performed with 10-11 mg hyperbaric bupivacaine and 15 µg fentanyl. After the surgery, in the QLBi group, 0.4 mL/kg of 0.25% ropivacaine was injected into the bilateral quadratus lumborum muscle under ultrasound guidance (the total volume was 0.8 mL/kg). In the placebo group, instead of ropivacaine, the subjects were injected with the same amount of normal saline. The primary outcome measure was elapsed time to first analgesic use from the QLBi block after cesarean section. RESULTS The data from all 36 patients were analyzed. There were no significant differences between the QLBi and placebo groups regarding elapsed time to first postoperative analgesic use [mean 230 (standard deviation 103) vs 194 (89) min; 95% confidence interval - 101 to 30; p = 0.27]. CONCLUSIONS QLBi with the concentration and amount of local anesthetic used in the present study was clinically slightly effective, and the effect was limited for postoperative analgesia after cesarean section.
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15
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Ueshima H, Otake H. Ultrasound-guided supra-iliac anterior quadratus lumborum block provides effective perioperative analgesia for total hip arthroplasty. J Clin Anesth 2020; 59:2. [DOI: 10.1016/j.jclinane.2019.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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16
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Urits I, Ostling PS, Novitch MB, Burns JC, Charipova K, Gress KL, Kaye RJ, Eng MR, Cornett EM, Kaye AD. Truncal regional nerve blocks in clinical anesthesia practice. Best Pract Res Clin Anaesthesiol 2019; 33:559-571. [DOI: 10.1016/j.bpa.2019.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 11/29/2022]
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17
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Kukreja P, MacBeth L, Sturdivant A, Morgan CJ, Ghanem E, Kalagara H, Chan VWS. Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study. Reg Anesth Pain Med 2019:rapm-2019-100804. [PMID: 31653800 DOI: 10.1136/rapm-2019-100804] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/22/2019] [Accepted: 10/11/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Quadratus lumborum (QL) block is a new regional analgesic technique for upper and lower abdominal surgeries as part of a multimodal analgesic regime. It has also been reported to relieve pain after total hip arthroplasty (THA). In this prospective, randomized, double-blind study, we compared QL block with control (no block) in patients undergoing primary THA. METHODS Eighty patients undergoing primary THA surgery under spinal anesthesia were randomized into two groups, one with and one without QL block. The patients in both groups were randomized after sedation, positioning and ultrasound scanning. Both the patient and the researcher collecting data were blinded to the patient's group assignment. Opioid consumption and visual analog scores (VAS) pain scores were measured at 12, 24, and 48 hours after surgery. Also, the ambulation distance, patient satisfaction, and length of stay were recorded. RESULTS The study analysis included 36 patients in the QL group and 35 patients in the control group. Both VAS pain score at 24 hours (difference -1.76, 95% CI -2.87 to -0.64) and cumulative opioid consumption were significantly lower in the QL group at 12, 12-24, 24, 24-48, and 48 hours after surgery as compared with the control group (difference at 48 hours -36.13, 95% CI -62.89 to -9.37) (p<0.05). However, there was no difference in pain score at 12 and 48 hours, nor in the ambulation distance and duration of hospital stay between the two groups. The patient satisfaction score was significantly higher in the QL group. CONCLUSIONS Our preliminary data show that the QL block provided effective analgesia and decreased opioid requirements up to 48 hours after primary THA. TRIAL REGISTRATION NUMBER NCT03408483.
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Affiliation(s)
- Promil Kukreja
- Department of Anesthesiology and Perioperative Medicine, UAB, Birmingham, Alabama, USA
| | - Lisa MacBeth
- Department of Anesthesiology and Perioperative Medicine, UAB, Birmingham, Alabama, USA
| | - Adam Sturdivant
- Department of Anesthesiology and Perioperative Medicine, UAB, Birmingham, Alabama, USA
| | | | - Elie Ghanem
- Department of Orthopaedics Surgery, UAB, Birmingham, Alabama, USA
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, UAB, Birmingham, Alabama, USA
| | - Vincent W S Chan
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
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