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Mirkheshti A, Hashemian M, Abtahi D, Shayegh S, Manafi-Rasi A, Sayadi S, Memary E, Karami N, Rostamian B, Shakeri A. Quadratus Lumborum Block versus Fascia Iliaca Compartment Block for Acetabular Fracture Surgery by Stoppa Method: A Double-Blind, Randomized, Noninferiority Trial. Pain Res Manag 2024; 2024:3720344. [PMID: 38223902 PMCID: PMC10787012 DOI: 10.1155/2024/3720344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/25/2023] [Accepted: 12/02/2023] [Indexed: 01/16/2024]
Abstract
Background Acetabular fracture surgeries are frequently accompanied by protracted and severe perioperative pain, and there is no consensus on optimal pain relief management. Aim This study aimed at comparing the analgesic efficacy of fascia iliaca compartment block (FICB) and quadratus lumborum block (QLB) in patients with acetabular fractures undergoing surgery using the Stoppa method. Methods In this double-blind, randomized, noninferiority clinical trial, adult patients undergoing spinal anesthesia for acetabular fracture surgery, in Imam Hossein Hospital, Tehran, Iran (IRCT20191114045435N1), were randomly divided into two groups: FICB (n = 22) and QLB (n = 24). The visual analog scale (VAS) was used to assess the pain intensity at different times for all participants. In addition, the dose of fentanyl required to induce the patient to sit for spinal anesthesia and the pain intensity were evaluated. Moreover, the duration of analgesia and the total amount of morphine consumed in the first 24 h following surgery were evaluated, analyzed, and compared between the two study groups. Results FICB and QLB demonstrated effective comparative postoperative analgesic profiles following acetabular fracture surgery; however, no significant differences in VAS values were observed between the two groups during the study. FICB experienced reduced cumulative fentanyl consumption during spinal anesthetic placement, whereas QLB had a significantly lower total morphine demand in the initial postoperative 24 h period. Conclusion The lateral QLB and FICB can be introduced as effective routes for analgesia in acetabular fracture surgery using the Stoppa method. Clinical Trial Registration. The study was prospectively registered in the clinical trials registry system, on 2021-02-17, with registration number: IRCT20191114045435N1.
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Affiliation(s)
- Alireza Mirkheshti
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Hashemian
- Department of Anesthesiology and Pain Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Dariush Abtahi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Shayegh
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Manafi-Rasi
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Sayadi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Memary
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazli Karami
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Baharak Rostamian
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Shakeri
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Umeh UO, Kaplan DJ, Diskina D, Commeh E, Cuff G, Hertling A, Youm T. Transmuscular Quadratus Lumborum Block Does Not Provide Significant Benefit for Primary Hip Arthroscopy with Pericapsular Infiltration: A Randomized Control Trial. Arthroscopy 2023; 39:2456-2463. [PMID: 37100214 DOI: 10.1016/j.arthro.2023.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 03/12/2023] [Accepted: 03/23/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE To prospectively evaluate the effectiveness of the transmuscular quadratus lumborum block (TQLB) with pericapsular injection (PCI) versus PCI alone in patients undergoing hip arthroscopy for treatment of femoroacetabular impingement (FAI) in terms of perioperative pain control, as well as postoperative function in the postoperative anesthesia unit (PACU) setting. METHODS Patients undergoing hip arthroscopy for FAI were prospectively randomized to receive 30 mL of 0.5% bupivacaine in a TQLB (n = 52) with PCI versus PCI alone (n = 51). The PCI included 20 mL of 0.25% bupivacaine given by the surgeon. All analyzed patients received general anesthesia. The primary outcome was postoperative pain scores assessed via the numerical rating scale (NRS) at 30 minutes postoperatively and immediately prior to discharge. Secondary outcomes were opioid utilization, expressed as morphine milligram equivalents (MMEs), PACU recovery time, quadriceps strength (assessed after completion of PACU phase 1 criteria), and adverse events (nausea/vomiting). RESULTS Average age, body mass index, and preoperative pain assessment were not significantly different between groups. There were no differences in NRS pain scores preoperatively, 30 minutes postoperatively, or immediately prior to discharge between groups (P > .05). Intraoperative opioid consumption was significantly lower in the TQLB group (MME: 16.8 ± 7.9) compared to controls (MME 20.6 ± 8.0; P = .009). However, there was no difference in the total opioid consumption (P > .05). There was no significant difference in total PACU length of stay (minutes) between the treatment (133.0 ± 48) and control groups (123.5 ± 47; P > .05). Quadriceps weakness was not significantly different between groups (P = .2). There was no difference in the number of patients that experienced nausea or vomiting between the TQLB group and control group (13% vs 16%; P = .99). Neither group had any reported serious adverse events. CONCLUSIONS TQLB and PCI do not improve postoperative pain scores or total opioid consumption compared to PCI alone. TQLB may decrease the amount of intraoperative opiate usage. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Uchenna O Umeh
- NYU Langone Health, New York University Langone Medical Center, New York, New York, U.S.A..
| | - Daniel J Kaplan
- NYU Langone Health, New York University Langone Medical Center, New York, New York, U.S.A
| | - Dina Diskina
- NYU Langone Health, New York University Langone Medical Center, New York, New York, U.S.A
| | - Ekow Commeh
- NYU Langone Health, New York University Langone Medical Center, New York, New York, U.S.A
| | - Germaine Cuff
- NYU Langone Health, New York University Langone Medical Center, New York, New York, U.S.A
| | - Arthur Hertling
- NYU Langone Health, New York University Langone Medical Center, New York, New York, U.S.A
| | - Thomas Youm
- NYU Langone Health, New York University Langone Medical Center, New York, New York, U.S.A
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Smith EB, Deirmengian GK. Local Anesthesia Approach for Percutaneous Screw Fixation of an Impacted Subcapital Femoral Neck Fracture: A Technique for High-Risk Patients. Cureus 2023; 15:e38532. [PMID: 37273309 PMCID: PMC10239204 DOI: 10.7759/cureus.38532] [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: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Elderly, frail patients and those who have substantial medical co-morbidities who sustain hip fractures present a challenging problem for treatment as they are at very high risk for complications from surgical intervention. The functional outcomes, pain levels, and mortality rates all worsen when non-surgical treatment is used. The safety of administering general or spinal anesthesia may be a concern in certain cases. Other modalities, such as epidural or caudal anesthesia, may be an option; however, the use of local anesthesia may be advantageous for patients with non-displaced and impacted femoral neck fractures undergoing surgical intervention. We present a case report describing the successful treatment of an elderly male who had relative contraindications to spinal anesthesia and high risk for general anesthesia and was successfully treated with percutaneous screw fixation of a femoral neck fracture using local anesthesia with a light, monitored anesthetic.
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Affiliation(s)
- Eric B Smith
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
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Crutchfield CR, Schweppe EA, Padaki AS, Steinl GK, Roller BA, Brown AR, Lynch TS. A Practical Guide to Lower Extremity Nerve Blocks for the Sports Medicine Surgeon. Am J Sports Med 2023; 51:279-297. [PMID: 35437023 DOI: 10.1177/03635465211051757] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Peripheral nerve blocks (PNBs) are vital in the administration of surgical analgesia and have grown in popularity for use in lower extremity arthroscopic procedures because of their capacity to safely and effectively control pain. The number and specificity of PNBs, however, have made choosing the best option for a procedure nebulous for orthopaedic surgeons. PURPOSE To present a narrative literature review of the PNBs available for arthroscopic hip and knee procedures that is adapted to an audience of orthopaedic surgeons. STUDY DESIGN Narrative literature review. METHODS A combination of the names of various lower extremity PNBs AND "hip arthroscopy" OR "knee arthroscopy" was used to search the English medical literature including PubMed, Cochrane Library, ScienceDirect, Embase, and Scopus. Placement technique, specificity of blockade, efficacy, and complications were assessed. Searches were performed through May 2, 2021. RESULTS A total of 157 studies were included in this review of lower extremity PNBs. Femoral nerve, lumbar plexus, sciatic nerve, and fascia iliaca compartment blocks were most commonly used in arthroscopic hip surgery, while femoral nerve, 3-in-1, and adductor canal blocks were preferred for arthroscopic knee surgery. Each block demonstrated a significant benefit (P > .05) in ≥1 of the following outcomes: intraoperative morphine, pain scores, nausea, and/or opioid consumption. Combination blocks including the lateral femoral cutaneous nerve block, obturator nerve block, quadratus lumborum block, and L1 and L2 paravertebral block have also been described. Complication rates ranged from 0% to 4.8% in those administered with ultrasound guidance. The most commonly reported complications included muscular weakness, postoperative falls, neuropathy, intravascular and intraneural injections, and hematomas. CONCLUSION When administered properly, PNBs were a safe and effective adjuvant method of pain control with a significant potential to limit postoperative narcotic use. While blockade choice varies by surgeon preference and procedure, all PNBs should be administered with ultrasound guidance, and vigilant protocols for the risk of postoperative falls should be exercised in patients who receive them.
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Affiliation(s)
| | - Eric A Schweppe
- Columbia University Irving Medical Center, New York, New York, USA
| | - Ajay S Padaki
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Brian A Roller
- Columbia University Irving Medical Center, New York, New York, USA
| | - Anthony R Brown
- Columbia University Irving Medical Center, New York, New York, USA
| | - T Sean Lynch
- Columbia University Irving Medical Center, New York, New York, USA
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Pooley R, Veneziano G, Burrier C, Tram NK, Tobias JD. Preliminary Experience With Quadratus Lumborum Catheters for Postoperative Pain Management in Pediatric-Aged Patients With Contraindications to Epidural Anesthesia. J Clin Med Res 2022; 14:425-431. [PMID: 36406942 PMCID: PMC9635806 DOI: 10.14740/jocmr4813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/23/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Although neuraxial techniques such as caudal and epidural anesthesia were initially the predominant regional anesthetic technique used to provide postoperative analgesia in children, there has been a transition to the use of peripheral nerve blockade such as the quadratus lumborum block (QLB). We present preliminary experience with QL catheters for continuous postoperative analgesia in a cohort of pediatric patients following colorectal surgery. METHODS After institutional review board (IRB) approval, we retrospectively reviewed the records of patients who underwent major colorectal surgery and received QL catheters for postoperative analgesia. The postoperative pain control data consisted of QL catheter characteristics, anesthetic agents, adjuncts, pain scores, and opioid consumption during the postoperative period. RESULTS The study cohort included eight pediatric patients, ranging in age from 1 to 19 years (median age 11.8 years). The QL catheters were placed in the operating room after the induction of anesthesia. Comorbid conditions in the cohort that were contraindications to neuraxial anesthesia included spinal/vertebral malformations, presence of a ventriculoperitoneal (VP) shunt, anal atresia, tracheo-esophageal fistula (VACTERL) association, and coagulation disturbances. All patients underwent complex colorectal or genito-urologic procedures. Bilateral QL catheters were placed in six patients, and unilateral catheters were placed in two patients. Four patients received 0.5% ropivacaine and four patients received 0.2% ropivacaine of an initial bolus. The local anesthetic used for continuous infusion was 0.2% ropivacaine in five patients, 0.1% ropivacaine in two patients, and 1.5% chloroprocaine in one patient, with a median infusion rate of 0.11 mL/kg/h. QL catheter infusions were supplemented with intravenous opioids delivered by patient-controlled or nurse-controlled analgesia. The median opioid requirements in oral morphine milligram equivalents (MME) were 1.2, 1.0, 1.1, 0.5, and 0.6 MME/kg on postoperative days 1 - 5. Daily median pain scores were ≤ 2 during the 5-day postoperative course. All catheters functioned successfully and were in place for a median of 79.3 h. Other than early inadvertent removal of two catheters, no adverse effects were noted. CONCLUSIONS Although our preliminary data suggest the efficacy of QL catheters in providing prolonged postoperative analgesia for up to 3 - 5 days following colorectal procedures, attention needs to be directed at measures to ensure that the catheter is secured to avoid inadvertent removal.
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Affiliation(s)
- Rachel Pooley
- Heritage College of Osteopathic Medicine, Dublin Campus, Dublin, Ohio and Ohio University, Athens, OH, USA
| | - Giorgio Veneziano
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Candice Burrier
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Nguyen K. Tram
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D. Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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Kelly T, Wolla CD, Wolf BJ, Hay E, Babb S, Wilson SH. Comparison of lateral quadratus lumborum and lumbar plexus blocks for postoperative analgesia following total hip arthroplasty: a randomized clinical trial. Reg Anesth Pain Med 2022; 47:541-546. [PMID: 35688515 PMCID: PMC10251218 DOI: 10.1136/rapm-2022-103598] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/02/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Effective analgesia after total hip arthroplasty must minimize pain and optimize early ambulation. Lumbar plexus blocks (LPBs) provide analgesia but may cause motor weakness. Quadratus lumborum blocks (QLBs) may provide analgesia with preserved motor strength. METHODS This trial randomized subjects scheduled for elective hip arthroplasty to receive an LPB or lateral QLB for postoperative analgesia. The primary outcome was opioid consumption at 12-hour postoperative. Non-inferiority of lateral QLBs compared with LPBs was conducted using a one-sided two-sample t-test. Secondary outcomes included pain scores, cumulative opioid consumption, quadriceps strength, time to ambulation, and distance ambulated. Differences in pain scores and opioid consumption over time between groups were evaluated using a linear mixed model. RESULTS The trial consented and randomized 111 subjects and 103 completed the study: LPB (n=50) and lateral QLB (n=53). Mean (95% CI) cumulative opioid consumption (mg) at 12-hour postoperative was not found to be non-inferior in the lateral QLB (15.9 (12.7 to 19.2)) vs the LPB (12.7 (10.2 to 15.1)) group (p=0.625). Pain scores in postoperative anesthetic care unit (PACU) and 24-hour postoperative did not differ. The maximum distance ambulated did not differ, but lateral QLB patients were 2.4 times more likely to ambulate in the first 12 hours (p=0.024) and had significantly greater quadriceps strength in PACU (p<0.001). DISCUSSION Although we were unable to demonstrate non-inferiority for opioid consumption at 12-hour postoperative, strength and mobilization were improved in lateral QLB subjects. TRIAL REGISTRATION NUMBER NCT04402437.
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Affiliation(s)
- Tara Kelly
- Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christopher D Wolla
- Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bethany J Wolf
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ellen Hay
- Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sarah Babb
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sylvia H Wilson
- Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Hashmi J, Cusack B, Hughes L, Singh V, Srinivasan K. Transmuscular Quadratus Lumborum Block versus Infrainguinal Fascia Iliaca Nerve Block for Patients Undergoing Elective Hip Replacement: A Double-blinded, Pilot, Randomized Controlled Trial. Local Reg Anesth 2022; 15:45-55. [PMID: 35833091 PMCID: PMC9272084 DOI: 10.2147/lra.s350033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Transmuscular quadratus lumborum (TQL) block has been described as an effective option for postoperative analgesia in patients undergoing hip replacement with single injection described as providing analgesia for up to 24 h. We hypothesize that a TQL block, when compared to fascia iliaca block (FIB), will provide better analgesia and less motor block in the initial 24-h postoperative period. Patients and Methods Fifty patients undergoing elective hip replacement surgery, ASA I–III, were included in the study. Patients were randomized into two groups. Patients in group A received spinal anesthesia followed by FIB. Patients in group B received spinal anesthesia followed by TQLB. Postoperative pain scores and motor block were assessed at 6 and 24 hours. The primary outcome measure was 24 h total morphine consumption. Secondary outcome measures included pain score (VNS) and motor block (modified Bromage scale) at 6 and 24 h postoperatively. Results There was no statistical difference in morphine consumption between the two groups (p-value 0.699). There was no difference in pain scores at 6 h (p-value 0.540) or 24 h (p-value 0.383). There was no difference in motor block at 6 h (p-value 0.497) or at 24 h (p-value 0.773). Conclusion Transmuscular quadratus lumborum block along with spinal anesthesia for patients undergoing elective hip replacement surgery does not reduce opioid consumption or motor weakness when compared to fascia iliaca block. The results and conclusion apply to a dose of 20 mL of 0.25% bupivacaine used in each group.
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Affiliation(s)
- Junaid Hashmi
- Department of Anaesthesia and Intensive Care, Tallaght University Hospital, Dublin, Ireland
| | - Barbara Cusack
- Department of Anaesthesia and Intensive Care, Tallaght University Hospital, Dublin, Ireland
| | - Lauren Hughes
- Department of Anaesthesia and Intensive Care, Tallaght University Hospital, Dublin, Ireland
| | - Vikash Singh
- Department of Anaesthesia and Intensive Care, Tallaght University Hospital, Dublin, Ireland
| | - Karthikeyan Srinivasan
- Department of Anaesthesia and Intensive Care, Tallaght University Hospital, Dublin, Ireland
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Abd Elmaksoud OSM, Elansary SEM, Fahmy NG, Hussien RM. A Comparative Study between Postoperative Analgesia of Fascia Iliaca Compartment Block and Anterior Quadratus Lumborum Block in Proximal Femur Fracture. Anesthesiol Res Pract 2022; 2022:3465537. [PMID: 35620036 PMCID: PMC9130016 DOI: 10.1155/2022/3465537] [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: 12/24/2021] [Revised: 03/18/2022] [Accepted: 04/15/2022] [Indexed: 11/23/2022] Open
Abstract
Elderly patients with various comorbidities are more likely to suffer from proximal femur fractures. It is also a painful fracture, and poor pain management can have serious physiological and psychological consequences, such as acute delirium. Purpose. The aim of this study is to compare the efficacy of ultrasound-guided transmuscular (anterior) quadratus lumborum block (QLB) versus infrainguinal fascia iliaca compartment block (FICB) in proximal femur fractures for postoperative analgesia. Patient-reported pain on the visual analogue scale (VAS), analgesic demand, and ambulation were the key factors. Patients and Methods. This prospective, randomised trial was done after receiving approval from the institute' study ethical committee. In this study, ultrasound-guided infrainguinal fascia iliaca compartment block was compared to ultrasound-guided anterior quadratus lumborum block using 50 ml of bupivacaine 0.25%, with a maximum dose of 2.5 mg/kg at the end of surgery after spinal anaesthesia in 128 patients (64 patients in each group). Nalbuphine was given as rescue analgesia if VAS >3. Our 1st outcome was the first rescue analgesia and total analgesic consumption in the 1st 24 hours; the 2nd outcome was the time patients started to ambulate. Results. Postoperative pain perception was substantially greater in the FICB group starting from 30 min (P value 0.022) till 24 hours (P value <0.001), and they received a considerably larger total narcotic dose (14.1 ± 3.5) than patients in the QLB group (7.9 ± 3.4), P value (<0.001 ∗ ). The time required to achieve first rescue analgesia was much less in the FICB group (8.5 ± 2.2) compared to the QLB group (14.1 ± 4.5), P value (<0.001 ∗ ), and they took much longer to ambulate (22.3 ± 4.8) when compared to the QLB group (20.1 ± 4.6), P value (0.011 ∗ ). Hypotension (1.6%) was detected mainly in the QLB group, whereas poor fascial separation (1.6%) was observed only in the FICB group. There were no significant differences in complications between both the FICB and QLB groups. Conclusion. Patients receiving postoperative anterior QL block for proximal femur fracture demonstrated delayed first rescue analgesia and lower total nalbuphine consumption with early ambulation than patients who received FICB.
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Affiliation(s)
- O. S. M. Abd Elmaksoud
- Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - S. E. M. Elansary
- Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - N. G. Fahmy
- Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - R. M. Hussien
- Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Huda AU, Minhas R. Quadratus Lumborum Block Reduces Postoperative Pain Scores and Opioids Consumption in Total Hip Arthroplasty: A Meta-Analysis. Cureus 2022; 14:e22287. [PMID: 35350514 PMCID: PMC8932597 DOI: 10.7759/cureus.22287] [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] [Accepted: 02/16/2022] [Indexed: 11/05/2022] Open
Abstract
Quadratus lumborum block (QL) is a relatively new regional anesthesia technique that has been used in different surgeries for improved outcomes. There are few case reports and studies about its role in total hip arthroplasty with variable effects. This study aimed to evaluate the effect of QL block on postoperative pain control, opioid consumption, and the incidence of postoperative adverse events in total hip arthroplasty surgeries. A systematic review of the scientific literature addressing the use of QL block in hip arthroplasty was performed following the PRISMA guidelines and using the online database databases, Medline and Science Direct. We registered this review with the PROSPERO database in May 2021 (reference number-CRD42021247055). Two authors performed the literature searches in June 2021 and repeated them in July 2021 to ensure accuracy. Review Manager software (RevMan for Mac, version 5.4; Cochrane Collaboration, Oxford, United Kingdom) was used to perform a meta-analysis of studies included in our review. Five randomized controlled trials were identified for inclusion (n=394) in our meta-analysis. The results demonstrated a beneficial effect of QL block in pain control at 6, 12, and 24 hours postoperatively after hip arthroplasty (p <0.05). Opioid consumption for 24 hours was significantly reduced in the QL group (p=0.010). Our study also demonstrated that QL block is associated with a significant reduction in postoperative nausea and vomiting (PONV) (p=0.04). In conclusion, QL block can provide significantly better pain control after total hip arthroplasty at 6, 12, and 24 hours postoperatively. It also results in significantly reduced 24 hour-opioid consumption. This block is also associated with a lesser incidence of PONV and a better satisfaction level postoperatively.
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Viscasillas J, Terrado J, Marti-Scharfhausen R, Castiñeiras D, Esteve V, Clancy N, Redondo JI. A Modified Approach for the Ultrasound-Guided Quadratus Lumborum Block in Dogs: A Cadaveric Study. Animals (Basel) 2021; 11:ani11102945. [PMID: 34679966 PMCID: PMC8532639 DOI: 10.3390/ani11102945] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary This study describes a modified approach for the ultrasound-guided quadratus lumborum block in dogs. Previous studies carried out in canine cadavers describe the needle insertion following a ventro-lateral to dorso-medial approach. Our modified technique follows a dorso-lateral to ventro-medial direction. We aimed to have the same success with this approach as previous studies in dogs but to minimise the potential complications. After performing the modified technique bilaterally in nine canine cadavers and administering contrast, we assessed the contrast distribution with computed tomography (CT) and dissection. Potential complications were also assessed. Our dissection results showed similar distribution to previous studies, although CT results showed a more caudal contrast spreading. No contrast was found in the abdomen or epidural space. This study shows that our modified approach is safe and has at least the same distribution as the previous studies published in dogs. Abstract Ultrasound-guided quadratus lumborum block (QLB) is a locoregional technique described in canine cadavers. The aim of this study was to assess a modified approach to QLB to minimise potential complications such as abdominal organ puncture. Nine canine cadavers were included and were positioned in lateral recumbency. An ultrasound-guided QLB was performed on each side. The probe was placed in the transverse position over the lumbar muscles just caudal to the last rib, and a needle was advanced in-plane from a dorso-lateral to a ventro-medial. A volume of 0.2 mL kg−1 of a mixture of iomeprol and methylene blue was injected. Computed tomography (CT) and dissection were performed to evaluate the spreading. Success was defined as staining of the nerve with a length of more than 0.6 cm. Potential complications such as intra-abdominal, epidural, or intravascular spreading of the mixture were also assessed. The CT images showed a T13 to L7 vertebra distribution, with a median of 5 (3–6). Dissection showed staining of the nerves from T13 to L4, with a median of 3 (2–5). No complications were found. This modified approach to QLB is safe and shows similar results to the previous studies in canine carcass.
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Affiliation(s)
- Jaime Viscasillas
- Departamento Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain; (J.T.); (R.M.-S.); (V.E.); (J.I.R.)
- Correspondence:
| | - Jose Terrado
- Departamento Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain; (J.T.); (R.M.-S.); (V.E.); (J.I.R.)
| | - Reyes Marti-Scharfhausen
- Departamento Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain; (J.T.); (R.M.-S.); (V.E.); (J.I.R.)
| | - Diego Castiñeiras
- Willows Veterinary Centre & Referral Service, Highlands Rd, Shirley, Solihull B90 4NH, UK;
| | - Vicente Esteve
- Departamento Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain; (J.T.); (R.M.-S.); (V.E.); (J.I.R.)
| | - Niamh Clancy
- The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK;
| | - Jose Ignacio Redondo
- Departamento Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain; (J.T.); (R.M.-S.); (V.E.); (J.I.R.)
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Anterior Quadratus Lumborum Block Does Not Provide Superior Pain Control after Hip Arthroscopy: A Double-Blinded Randomized Controlled Trial. Anesthesiology 2021; 135:433-441. [PMID: 34237132 DOI: 10.1097/aln.0000000000003853] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hip arthroscopy is associated with moderate to severe postoperative pain. This prospective, randomized, double-blinded study investigates the clinically analgesic effect of anterior quadratus lumborum block with multimodal analgesia compared to multimodal analgesia alone. The authors hypothesized that an anterior quadratus lumborum block with multimodal analgesia would be superior for pain control. METHODS Ninety-six adult patients undergoing ambulatory hip arthroscopy were enrolled. Patients were randomized to either a single-shot anterior quadratus lumborum block (30 ml bupivacaine 0.5% with 2 mg preservative-free dexamethasone) or no block. All patients received neuraxial anesthesia, IV sedation, and multimodal analgesia (IV acetaminophen and ketorolac). The primary outcome was numerical rating scale pain scores at rest and movement at 30 min and 1, 2, 3, and 24 h. RESULTS Ninety-six patients were enrolled and included in the analysis. Anterior quadratus lumborum block with multimodal analgesia (overall treatment effect, marginal mean [standard error]: 4.4 [0.3]) was not superior to multimodal analgesia alone (overall treatment effect, marginal mean [standard error]: 3.7 [0.3]) in pain scores over the study period (treatment differences between no block and anterior quadratus lumborum block, 0.7 [95% CI, -0.1 to 1.5]; P = 0.059). Postanesthesia care unit antiemetic use, patient satisfaction, and opioid consumption for 0 to 24 h were not significantly different. There was no difference in quadriceps strength on the operative side between groups (differences in means, 1.9 [95% CI, -1.5 to 5.3]; P = 0.268). CONCLUSIONS Anterior quadratus lumborum block may not add to the benefits provided by multimodal analgesia alone after hip arthroscopy. Anterior quadratus lumborum block did not cause a motor deficit. The lack of treatment effect in this study demonstrates a surgical procedure without benefit from this novel block. EDITOR’S PERSPECTIVE
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Diwan S, Nair A. Lumbar erector spinae plane block obtunding knee and ankle reflexes. Saudi J Anaesth 2021; 15:222-224. [PMID: 34188648 PMCID: PMC8191250 DOI: 10.4103/sja.sja_79_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 01/26/2020] [Indexed: 11/05/2022] Open
Abstract
The erector spinae plane block (ESPB) has recently been described as an effective analgesic strategy for various surgeries at ventral and dorsal parts of body. The block has been utilized for postoperative pain relief in hip surgeries. Cadaveric and clinical studies performed at the lumbar level depict a dorsal spread and minimal ventral spread in the lumbar plexus. So far to our knowledge there is one case report which has described reduced quadriceps strength in a parturient after caesarean section. We report two patients who presented with absent knee reflexes (decreased quadriceps strength) and one patient with absent ankle reflex (foot drop) following continuous ESPB at the level of L3. The initial bolus was with 30 ml of 0.1% bupivacaine followed by a continuous infusion of 0.1% ropivacaine at 8ml/hour. The loss of knee reflexes in two patients and diminished reflexes in one patient suggested spread of local anaesthetic (LA) to the lumbosacral plexus. The LA infusion were stopped in all 3 patients. The average duration of motor block was 18 hours. These complications should be considered if early ambulation is mandatory for patients.
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Affiliation(s)
- Sandeep Diwan
- Department of Anaesthesiology, Sancheti Hospital, Pune, Maharashtra, India
| | - Abhijit Nair
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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Ong Sio LC, Vo C, Bautista A. Quadratus Lumborum Block as a Rescue Block Following Total Hip Arthroplasty. PAIN MEDICINE 2021; 22:746-749. [PMID: 33155029 DOI: 10.1093/pm/pnaa387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Lady Christine Ong Sio
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Christine Vo
- Department of Anesthesiology and Pain Medicine, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Alexander Bautista
- Department of Anesthesiology and Perioperative Medicine, University of Louisville , Louisville, Kentucky, USA
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A Comparative Analysis of the Quadratus Lumborum Block Versus Femoral Nerve and Fascia Iliaca Blocks in Hip Arthroscopy. Arthrosc Sports Med Rehabil 2020; 3:e7-e13. [PMID: 33615242 PMCID: PMC7879192 DOI: 10.1016/j.asmr.2020.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/18/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose To evaluate the effect of the single-shot quadratus lumborum (QL) block versus femoral nerve and fascia iliacus (F/FI) blocks performed preoperatively on perioperative opioid requirements, subjective pain scores, and time to discharge. Methods Patients who underwent hip arthroscopy for femoroacetabular impingement and had a preoperative nerve block between January 2017 and August 2019 at our institution were identified. Patients were separated into 2 groups: those who either received a preoperative single-shot QL block or a preoperative single-shot F/FI block. All patients received general anesthesia. Intraoperative, postanesthesia care unit (PACU), and total morphine equivalents were analyzed using unpaired t test. Secondary outcome measures including total time in PACU and block-related complications were recorded and analyzed as well. Results One hundred one patients were retrospectively reviewed. Forty-three patients received preoperative QL blocks, and 58 patients received preoperative F/FI blocks. Demographics and operative characteristics were similar between the 2 groups. Patients receiving a QL block required significantly lower total morphine equivalents (63.1 vs 87.0, P < .001). Patients receiving a QL block also had shorter PACU stays (116 vs 148 minutes, P < .001) and lower subjective pain scores at the time of discharge (3.27 vs 4.98, P < .001) compared with the F/FI block group. There were also significant decreases in the number of intraoperative opioids (42.1 vs 58.4, P < .001) and PACU opioids (20.7 vs 28.7, P = .03) used when analyzed separately. Two patients in the femoral nerve block group had noted a fall postoperatively while the block was in effect. No patients in the QL block group had a block-related complication. Conclusions Patients receiving a preoperative QL block for hip arthroscopy demonstrated lower total opioid requirements, shorter PACU stay, and lower pain scores at discharge than patients receiving preoperative F/FI blocks with no reported adverse events. Level of Evidence Level III, retrospective comparative trial.
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Abduallah MA, Ahmed SA, Abdelghany MS. The effect of post-operative ultrasound-guided transmuscular quadratus lumborum block on post-operative analgesia after hip arthroplasty in elderly patients: A randomised controlled double-blind study. Indian J Anaesth 2020; 64:887-893. [PMID: 33437078 PMCID: PMC7791433 DOI: 10.4103/ija.ija_275_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/15/2020] [Accepted: 07/15/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aim The best analgesic technique after hip surgeries is a matter of debate. This clinical trial aimed to assess the effect of transmuscular ultrasound-guided quadratus lumborum (QL) block on post-operative analgesic consumption after hip arthroplasty in elderly patients. Methods This prospective randomised double-blind study was carried out on 60 patients aged 60-80 years presented for total hip replacement under unilateral spinal anaesthesia. Patients were randomly allocated to one of two groups: A control group, receiving sham transmuscular QL block (QLB) (1 ml of normal saline), and a QL group, receiving real transmuscular QLB (30 ml of plain bupivacaine 0.25%). Post-operative morphine consumption (primary outcome), post-operative pain score (secondary outcome), time to the first request of rescue analgesia, patient's satisfaction and the occurrence of post-operative complications were measured. Results Compared to the control group, the use of QLB in the second group significantly decreased intravenous morphine consumption postoperatively from 8.50 ± 3.06 mg to 5.60 ± 3.22 mg (P = 0.0007) with a significant prolongation of the time to the first call for analgesia (P < 0.0001). It also decreased the post-operative visual analogue score 4 h, 6 h and 8 h postoperatively (P < 0.05). However, there was no difference between both the groups regarding patient's satisfaction and the occurrence of complications (P > 0.05). Conclusion The use of transmuscular QLB in patients undergoing total hip replacement decreased post-operative analgesic consumption and post-operative pain score and prolonged post-operative analgesia. It did not affect patients' satisfaction and occurrence of post-operative complications.
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Affiliation(s)
- Mohammad Ali Abduallah
- Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Al Gharbia Governate, Egypt
| | - Sameh Abdelkhalik Ahmed
- Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Al Gharbia Governate, Egypt
| | - Mohamed Shebl Abdelghany
- Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Al Gharbia Governate, Egypt
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Kim SH, Kim HJ, Kim N, Lee B, Song J, Choi YS. Effectiveness of quadratus lumborum block for postoperative pain: a systematic review and meta-analysis. Minerva Anestesiol 2020; 86:554-564. [DOI: 10.23736/s0375-9393.20.13975-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Ultrasound-Guided Transmuscular Quadratus Lumborum Block Reduces Postoperative Pain Intensity in Patients Undergoing Total Hip Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial. Pain Res Manag 2020; 2020:1035182. [PMID: 32256907 PMCID: PMC7085398 DOI: 10.1155/2020/1035182] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 02/03/2020] [Accepted: 02/13/2020] [Indexed: 11/18/2022]
Abstract
Methods Eighty-eight patients undergoing THA were randomized to receive 0.33% ropivacaine (Group QLB, n = 44) or saline (Group Con, n = 44) for QL3 block. Spinal anesthesia was then performed. Pain intensity was assessed using the visual analog scale (0: no pain to 10: worst possible pain). The primary outcome was pain scores recorded at rest at 3, 6, 12, 24, 36, and 48 h and on standing and walking at 24, 36, and 48 h postoperatively. Secondary outcomes were analgesic consumption, side effects, the 10-meter walking speed on day 6, and patient satisfaction after surgery. Results Postoperative pain intensity was significantly lower in Group QLB compared to Group Con at rest after 3, 6, 12, 24, 36, and 48 h (p < 0.001) and during mobilization after 24, 36, and 48 h (p < 0.001). Morphine use was significantly lower in Group QLB compared to Group Con during 0–24 h (16.0 ± 7.1 vs. 34.1 ± 7.1 mg, p < 0.001) and during 24–48 h (13.0 ± 4.0 vs. 17.4 ± 4.6 mg, p < 0.001) postoperatively. The 10-meter walking speed was higher in Group QLB compared to Group Con, both at comfortable (0.79 ± 0.13 vs. 0.70 ± 0.14 m/s, p=0.012) and at maximum speeds (1.18 ± 0.26 vs. 1.06 ± 0.22 m/s, p < 0.001). Incidences of nausea (7.3% vs. 31%, p=0.006), vomiting (7.3% vs. 26.2%, p = 0.022), and urinary retention (9.8% vs. 28.6%, p=0.030) were lower in Group QLB than in Group Con. Conclusions Ultrasound-guided QL3 block is an effective pain management technique after THA.
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Kikuchi M, Mihara T, Mizuno Y, Fujimoto H, Arai S, Nomura T, Goto T. Anterior quadratus lumborum block for postoperative recovery after total hip arthroplasty: a study protocol for a single-center, double-blind, randomized controlled trial. Trials 2020; 21:142. [PMID: 32024551 PMCID: PMC7003356 DOI: 10.1186/s13063-020-4090-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/18/2020] [Indexed: 12/26/2022] Open
Abstract
Background Appropriate pain management is essential to improve the postoperative recovery after total hip arthroplasty (THA). Various case reports have indicated that anterior quadratus lumborum block (QLB) provides effective postoperative analgesia in lower limb surgeries. However, few randomized controlled trials have confirmed the efficacy of anterior QLB for lower limb surgeries. The aim of this single-center, double-blind, randomized controlled trial is to confirm the efficacy of anterior QLB for postoperative recovery after THA. Methods The participants will be randomly assigned to either the anterior QLB or placebo groups, using a set of random numbers for the allocation sequence. Only pharmacists will be aware of the allocations; other investigators will be blinded until study completion. After induction of general anesthesia, anterior QLB will be performed by using 0.25% levobupivacaine or normal saline. Fentanyl will be administered according to blood pressure change during the surgery. The primary outcome will be the quality of recovery 40 score (QoR-40). Secondary outcomes will include the visual analog scale score of pain intensity at rest and movement, intraoperative and postoperative doses of fentanyl, and incidence of postoperative nausea and vomiting. Statistical analysis will be performed by using the Student’s t test, Mann–Whitney U test, and Fisher’s exact test as appropriate. A P value of less than 0.05 will be considered statistically significant. Discussion The results of our study will reveal whether anterior QLB is effective for postoperative recovery after THA. Trial registration UMIN Clinical Trials Registry, UMIN000032255. Registered on 15 April 2018.
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Affiliation(s)
- Masaru Kikuchi
- Department of Anesthesiology, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama city, 236-0004, Japan
| | - Takahiro Mihara
- Department of Anesthesiology, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama city, 236-0004, Japan.
| | - Yusuke Mizuno
- Department of Anesthesiology, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama city, 236-0004, Japan
| | - Hiroko Fujimoto
- Department of Anesthesiology, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama city, 236-0004, Japan
| | - Sachiko Arai
- Department of Pharmacy, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama city, 236-0004, Japan
| | - Takeshi Nomura
- Department of Intensive Care Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Takahisa Goto
- Department of Anesthesiology, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama city, 236-0004, Japan
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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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Vilhelmsen F, Nersesjan M, Andersen JH, Danker JK, Broeng L, Hägi-Pedersen D, Mathiesen O, Thybo KH. Lateral femoral cutaneous nerve block with different volumes of Ropivacaine: a randomized trial in healthy volunteers. BMC Anesthesiol 2019; 19:165. [PMID: 31455249 PMCID: PMC6712695 DOI: 10.1186/s12871-019-0833-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 08/18/2019] [Indexed: 01/10/2023] Open
Abstract
Background Nerve block of the lateral femoral cutaneous nerve (LFCN) is a predominantly sensory block. It reduces pain following total hip arthroplasty (THA), but the non-responder rate is high. We hypothesized, that an increased volume of ropivacaine, would result in greater coverage of incisions used for THA. Methods We conducted a randomized, blinded trial in 20 healthy volunteers. Participants were randomized to receive bilateral LFCN-blocks with 8 mL ropivacaine 0.75% on the left side and 16 mL ropivacaine 0.75% on the right side, or vice versa. Allocation was blinded to both participants and outcome assessors. Before nerve block performance, incision lines for posterior and lateral THA approaches were depicted with invisible ultraviolet-paint, thereby securing sufficient blinding during outcome assessment. The blocked area was mapped using temperature and mechanical discrimination tests. Quadriceps muscle strength was monitored. Primary outcome was coverage of the posterior incision line assessed by temperature discrimination test. Results We found no difference in coverage of the posterior or lateral incision lines when comparing LFCN-blocks with 8 mL versus 16 mL of ropivacaine. The blocked area was significantly larger in the 16 mL group, assessed by both temperature discrimination test (p = 0.012) and mechanical discrimination test (p = 0.034). We observed no difference between groups regarding quadriceps muscle strength (p = 1.0). Conclusions A LFCN-block with increased volume of ropivacaine from 8 mL to 16 mL did not result in a greater coverage of posterior or lateral incision lines used for THA, but in a larger blocked sensory area. Trial registration Clinicaltrials.gov: NCT03138668. Registered 3rd of May 2017.
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Affiliation(s)
- Frederik Vilhelmsen
- Department of Anesthesiology, Naestved Hospital, Naestved, Denmark. .,CAR, Department of Anesthesiology, Centre of Anaesthesiological Research -ZealandUniversity Hospital, Koege, Denmark.
| | - Mariam Nersesjan
- Department of Anesthesiology, Naestved Hospital, Naestved, Denmark.,CAR, Department of Anesthesiology, Centre of Anaesthesiological Research -ZealandUniversity Hospital, Koege, Denmark
| | - Jakob Hessel Andersen
- CAR, Department of Anesthesiology, Centre of Anaesthesiological Research -ZealandUniversity Hospital, Koege, Denmark
| | - Jakob Klim Danker
- CAR, Department of Anesthesiology, Centre of Anaesthesiological Research -ZealandUniversity Hospital, Koege, Denmark
| | - Leif Broeng
- Department of Orthopedics, Zealand University Hospital, Koege, Denmark
| | | | - Ole Mathiesen
- CAR, Department of Anesthesiology, Centre of Anaesthesiological Research -ZealandUniversity Hospital, Koege, Denmark
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Abstract
PURPOSE OF REVIEW Hip fracture is common in the elderly population, painful and costly. The present investigation was undertaken to review epidemiology, socio-economic and medical implications, relevant anatomy, and anesthetic and pain modalities of hip fracture. RECENT FINDINGS A literature search of PubMed, Ovid Medline, and Cochrane databases was conducted in December 2018 to identify relevant published clinical trials, review articles, and meta-analyses studies related to anesthetic and pain modalities of hip fracture. The acute pain management in these situations is often challenging. Common issues associated with morbidity and mortality include patients' physiological decrease in function, medical comorbidities, and cognitive impairment, which all can confound and complicate pain assessment and treatment. Perioperative multidisciplinary and multimodal approaches require medical, surgical, and anesthesiology teams employing adequate preoperative optimization. Reduction in pain and disability utilizing opioid and non-opioid therapies, regional anesthesia, patient-tailored anesthetic approach, and delirium prevention strategies seems to ensure best outcomes.
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Li J, Lam D, King H, Credaroli E, Harmon E, Vadivelu N. Novel Regional Anesthesia for Outpatient Surgery. Curr Pain Headache Rep 2019; 23:69. [PMID: 31372836 DOI: 10.1007/s11916-019-0809-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Peripheral nerve blocks are effective and safe modalities for perioperative analgesia. But it remains unclear what blocks are adequate for ambulatory surgeries, as well as the proper patient management before and after discharge. RECENT FINDINGS Emerging nerve blocks have sparked interests due to ease to perform under ultrasound guidance and lower risks of adverse events. Some of these novel blocks are particularly suitable for ambulatory procedures, including but not limited to motor-sparing lower extremity nerve blocks and phrenic-sparing nerve blocks for shoulder surgeries. The adoption of peripheral nerve block into outpatient surgery is a multidisciplinary effort that encompasses appropriate patient choice, careful selection of nerve blocks that minimize potential adverse events after discharge, and proper patient follow-up until block effects resolve.
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Affiliation(s)
- Jinlei Li
- Department of Anesthesiology, Yale University, New Haven, CT, USA.
| | - David Lam
- Department of Anesthesiology, Yale University, New Haven, CT, USA
| | - Hanna King
- Department of Anesthesiology, Yale University, New Haven, CT, USA
| | | | - Emily Harmon
- Department of Anesthesiology, Yale University, New Haven, CT, USA
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale University, New Haven, CT, USA
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Gupta A, Sondekoppam R, Kalagara H. Quadratus Lumborum Block: a Technical Review. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00338-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Plečko M, Bohaček I, Tripković B, Čimić M, Jelić M, Delimar D. Applications and critical evaluation of fascia iliaca compartment block and quadratus lumborum block for orthopedic procedures. Acta Clin Croat 2019; 58:108-113. [PMID: 31741568 PMCID: PMC6813479 DOI: 10.20471/acc.2019.58.s1.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Anterior section of the hip joint capsule is innervated by femoral nerve and obturator nerve, and posterior section is innervated by the nerve to quadratus femoris muscle and occasionally by the superior gluteal (posterolateral region) and sciatic nerve (posterosuperior region). One of the regional anesthesia options for hip surgery is the fascia iliaca compartment block (FICB) that affects nerves important for hip innervation and sensory innervation of the thigh - femoral, obturator and lateral femoral cutaneous nerve. FICB can be easily performed and is often a good solution for management of hip fractures in emergency departments. Its use reduces morphine pre-operative requirement for patients with femoral neck fractures and can also be indicated for hip arthroplasty, hip arthroscopy and burn management of the region. Quadratus lumborum block (QLB) is a block of the posterior abdominal wall performed exclusively under ultrasound guidance, with still unclarified mechanism of action. When considering hip surgery and postoperative management, the anterior QLB has shown to reduce lengthy hospital stay and opioid use, it improves perioperative analgesia in patients undergoing hip and proximal femoral surgery compared to standard intravenous analgesia regimen, provides early and rapid pain relief and allows early ambulation, thus preventing deep vein thrombosis and thromboembolic complications etc. However, some nerve branches responsible for innervation of the hip joint are not affected by QLB, which has to be taken into consideration. QLB has shown potential for use in hip surgery and perioperative pain management, but still needs to be validated as a reliable treatment approach.
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Affiliation(s)
| | - Ivan Bohaček
- Department of Orthopaedic Surgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Branko Tripković
- Department of Orthopaedic Surgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mislav Čimić
- Department of Orthopaedic Surgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mislav Jelić
- Department of Orthopaedic Surgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Domagoj Delimar
- Department of Orthopaedic Surgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
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Bak H, Bang S, Yoo S, Kim S, Lee SY. Continuous quadratus lumborum block as part of multimodal analgesia after total hip arthroplasty: a case report. Korean J Anesthesiol 2019; 73:158-162. [PMID: 31096729 PMCID: PMC7113169 DOI: 10.4097/kja.d.19.00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/14/2019] [Indexed: 11/27/2022] Open
Abstract
Background Commonly used epidural or systemic analgesics for pain control after hip surgery carry risk for potential adverse effects. In contrast, the quadratus lumborum block (QLB) utilizes a simple and easy fascial plane technique and provides a wide area of sensory blockade. Thus, the QLB may be beneficial as analgesia after total hip arthroplasty. Case Here, we report the case of an 83-year-old man who received a continuous transmuscular QLB as part of a multimodal analgesia after hardware removal and total hip arthroplasty. The patient received a continuous infusion of 0.2% ropivacaine at 8 ml/h through an indwelling catheter in addition to patient-controlled analgesia with intravenous fentanyl and oral celecoxib. The patient’s pain scores did not exceed 4, and no additional analgesics were required until postoperative day 5. Conclusions Transmuscular QLB may be a suitable option for multimodal analgesia after total hip arthroplasty.
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Affiliation(s)
- Hahyeon Bak
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seunguk Bang
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Subin Yoo
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seoyeong Kim
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Yeon Lee
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Dîrzu DS, Dicu C, Dîrzu N. Urinary retention: a possible complication of unilateral continuous quadratus lumborum analgesia - a case report. Rom J Anaesth Intensive Care 2019; 26:75-78. [PMID: 31111099 PMCID: PMC6502277 DOI: 10.2478/rjaic-2019-0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/19/2019] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Continuous quadratus lumborum (QL) analgesia is a new option for proximal femur surgery considered safe and effective. The purpose of this report was to show that we may not be aware of all the possible complications of this technique, and urinary retention may occur even when the block is performed unilaterally. CASE REPORT To an obese, intubated, mechanically ventilated, female patient, operated in prone position for removal of a femur tumour, we performed a trans-muscular quadratus lumborum block (TQL). We mounted a catheter and administered continuous infusion of local anaesthetic in the postoperative period. The patient experienced urinary retention. A urinary catheter was placed and it was maintained for the entire period of local anaesthetic infusion. When the catheter was removed, 72 hours after the surgery, the patient resumed normal bladder functions. CONCLUSION Urinary retention is a possible complication when continuous quadratus lumborum analgesia is used, even when performed unilaterally.
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Affiliation(s)
- Dan Sebastian Dîrzu
- Department of Anaesthesiology and Intensive Care, University of Medicine and Pharmacy “Iuliu Haţieganu” Cluj-Napoca, Romania
| | - Cosmin Dicu
- Department of Orthopedy, Emergency County Hospital Cluj-Napoca, Romania
| | - Noémi Dîrzu
- Research Center for Advanced Medicine Medfuture, University of Medicine and Pharmacy “Iuliu Haţieganu” Cluj-Napoca, Romania
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The supra-iliac anterior quadratus lumborum block: a cadaveric study and case series. Can J Anaesth 2019; 66:894-906. [DOI: 10.1007/s12630-019-01312-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 01/14/2023] Open
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Abstract
A review of anatomy, potential mechanisms of action, and techniques and summary of clinical evidence for quadratus lumborum block.
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Stuart Green M, Ryan Hoffman C, Iqbal U, Olabisi Ives O, Hurd B. Transmuscular Quadratus Lumborum Block Reduces Length of Stay in Patients Receiving Total Hip Arthroplasty. Anesth Pain Med 2018; 8:e80233. [PMID: 30719411 PMCID: PMC6347734 DOI: 10.5812/aapm.80233] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/20/2018] [Accepted: 10/06/2018] [Indexed: 12/29/2022] Open
Abstract
Background Total hip arthroplasty is a common procedure being performed at an increasing rate in the United States. Recovering from this surgery to the extent that one can participate in criteria for discharge relies heavily on effective postoperative analgesia. Many regional anesthetic techniques are deployed in this realm. The recent utilization of quadratus lumborum (QL) blocks with success in other procedures warrants investigation in the hip arthroplasty population. Methods Twenty patients received general anesthesia for elective total hip arthroplasty. Ten cases included a preoperative ultrasound-guided transmuscular quadratus lumborum block with 30 cc 0.5% ropivacaine. Ten cases that lacked this regional procedure. The primary outcome was length of hospital stay. Secondary outcomes include total procedure time, intraoperative and postoperative fentanyl administration, and mean postoperative visual analog pain scores (VAS 1 - 10). Results Length of stay was shorter in patients receiving QL block (2.9 days) versus patients not receiving QL block (5.1 days) (P value 0.0146). Intra-operative use of fentanyl was lower in patients receiving QL block (183.5 mcg) versus patients not receiving QL block (240 mcg) (P value 0.0376). PACU narcotic utilization, 24-hour VAS score, and length of operative procedure lacked statistical significance, though the study was not powered for these outcomes. Conclusions QL block employment in hip surgery produces significant reduction in length of stay and intraoperative fentanyl use. While quadratus lumborum blocks are rapidly becoming a popular option due to its quality and spread of analgesia, more adequately powered prospective research must be performed to appropriately elucidate significant trends.
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Affiliation(s)
- Michael Stuart Green
- Department of Anesthesiology and Perioparative Medicine, Drexel University College of Medicine, Philadelphia, United States
- Corresponding Author: Department of Anesthesiology and Perioparative Medicine, Drexel University College of Medicine, Philadelphia, United States. Tel: +1-8563085034, E-mail:
| | - Christopher Ryan Hoffman
- Department of Anesthesiology and Perioparative Medicine, Drexel University College of Medicine, Philadelphia, United States
| | - Usama Iqbal
- Department of Anesthesiology and Perioparative Medicine, Drexel University College of Medicine, Philadelphia, United States
| | - Oluwafunke Olabisi Ives
- Department of Anesthesiology and Perioparative Medicine, Drexel University College of Medicine, Philadelphia, United States
| | - Benita Hurd
- Department of Anesthesiology and Perioparative Medicine, Drexel University College of Medicine, Philadelphia, United States
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McCrum CL, Ben-David B, Shin JJ, Wright VJ. Quadratus lumborum block provides improved immediate postoperative analgesia and decreased opioid use compared with a multimodal pain regimen following hip arthroscopy. J Hip Preserv Surg 2018; 5:233-239. [PMID: 30393550 PMCID: PMC6206687 DOI: 10.1093/jhps/hny024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/18/2018] [Accepted: 07/08/2018] [Indexed: 12/29/2022] Open
Abstract
The purpose of our study was to evaluate the effect on immediate patient outcomes following hip arthroscopy with use of a preoperative, single shot quadratus lumborum (QL) block. We retrospectively reviewed patients who underwent hip arthroscopy following a preoperative QL block. These patients were matched by age and gender to patients who had not received a block. Visual analogue scale (VAS) pain scores immediately postoperatively and at the time of discharge were recorded. Hourly and overall opioid intake in the postanesthesia care unit (PACU) was also recorded. Continuous data was analysed with paired t-test, with significance being defined as P < 0.05. Complications in the immediate postoperative period were recorded, as was time from admission to PACU to discharge. Fifty-six patients were included. Twenty-eight patients underwent QL block and 28 did not undergo a block. QL block patients required significantly less hydromorphone (P = 0.010) and oxycodone (P = 0.001) during their time in the PACU, and significantly fewer morphine equivalents overall and per hour in the PACU (P < 0.001). Despite receiving less opioid analgesia, QL block patients had significantly less pain immediately postoperatively (P = 0.026) and at the time of discharge (P = 0.015). The mean time to PACU discharge was 155 ± 49 min, and there was no difference in time to discharge between groups (P = 0.295). One patient in the QL block group experienced persistent flank numbness. Hip arthroscopy patients who received a preoperative QL block had less pain and a lower opioid requirement in PACU than those who did not receive a block. Level of Evidence: Level III (Retrospective matched cohort study).
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Affiliation(s)
- Christopher L McCrum
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Bruce Ben-David
- Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jason J Shin
- Department of Orthopaedics and Sports Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Vonda J Wright
- Northside Hospital Sports Medicine Network, Atlanta, GA, USA
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Quadratus Lumborum Block as Sole, Homeostatic-Preserving Anesthetic for a Patient with Multiple System Atrophy Undergoing Open Inguinal Hernia Repair: A Case Report. Case Rep Anesthesiol 2018; 2018:7161860. [PMID: 30050698 PMCID: PMC6046158 DOI: 10.1155/2018/7161860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 06/13/2018] [Indexed: 11/18/2022] Open
Abstract
Quadratus Lumborum (QL) block has been successfully used for different abdominal procedures in the past. Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized mainly by autonomic instability, motor impairment, and cognitive dysfunction. We report a case of a patient with MSA with a history of multiple episodes of unplanned admissions following outpatient minor surgical procedures under general anesthesia scheduled to undergo open inguinal hernia repair. In our patient, QL block was successfully used for surgical anesthesia and it resulted in hemodynamic stability and an opioid-free perioperative course.
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Cadaveric Evaluation of Different Approaches for Quadratus Lumborum Blocks. Pain Res Manag 2018; 2018:2368930. [PMID: 29991972 PMCID: PMC6016158 DOI: 10.1155/2018/2368930] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/06/2018] [Accepted: 05/20/2018] [Indexed: 11/17/2022]
Abstract
Background A quadratus lumborum (QL) block is an abdominal truncal block technique that primarily provides analgesia and anaesthesia to the abdominal wall. This cadaveric study was undertaken to compare the dye spread between different needle approaches for ultrasound-guided QL blocks in soft-embalmed cadavers. Methods After randomization, an experienced anesthesiologist performed two lateral, three posterior, and five alternative QL blocks on the left or right sides of five cadavers. The target injection point for the alternative approach was the lumbar interfascial triangle, same as that of conventional posterior QL block, with a different needle trajectory. For each block, 20 ml of dye solution was injected. The lumbar region and abdominal flank were dissected. Results Ten blocks were successfully performed. Regardless of the approach used, the middle thoracolumbar fascia was deeply stained in all blocks, but the anterior layer was less stained. The alternative approach was more associated with spread of injectate to the transversus abdominis and transversalis fascia plane. Despite accurate needle placement, all lateral QL blocks were associated with a certain amount of intramuscular or subcutaneous infiltration. Two posterior QL blocks showed a deeply stained posterior thoracolumbar fascia, and one of them was associated with obvious subcutaneous staining. The subcostal, iliohypogastric, and ilioinguinal nerves were mostly involved, but the thoracic paravertebral space and lumbar plexus were not affected in all blocks. Conclusions The alternative approach for QL blocks was able to achieve a comparable extent when compared to the conventional approach.
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Kumar K, Kirksey MA, Duong S, Wu CL. A Review of Opioid-Sparing Modalities in Perioperative Pain Management. Anesth Analg 2017; 125:1749-1760. [DOI: 10.1213/ane.0000000000002497] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Haskins SC, Nejim JA. In Response. Anesth Analg 2017; 125:364-365. [PMID: 28614122 DOI: 10.1213/ane.0000000000002193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Stephen C Haskins
- Department of Anesthesiology, Hospital for Special Surgery, New York, New York,
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Ben-David B, La Colla L. Extravasated Fluid in Hip Arthroscopy and Pain: Is Quadratus Lumborum Block the Answer? Anesth Analg 2017; 125:364. [PMID: 28609336 DOI: 10.1213/ane.0000000000002198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Bruce Ben-David
- Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PennsylvaniaDepartment of Anesthesiology, Duke University Medical Center, Durham, North Carolina,
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