Comparative study between three approaches of ultrasound guided quadratus lumborum block for post-operative analgesia in total hip replacement with spinal anaesthesia
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Keywords
Ultrasound-guided quadratus lumborum block; orthopedic lower limb; subarachnoid anesthesia
Abstract
Background: Early postoperative ambulation and reduction of hospital stay necessitate efficient postoperative analgesia. Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery.
Objective: compare between different approaches of ultrasound guided quadratus lumborum block for post-operative analgesia in total hip replacement with spinal anaesthesia.
Patients and Methods: This study was conducted in Orthopedic surgery operating unit in Al-Azhar University Hospitals (Al-Hussein and Sayed Galal), and approved by the ethics committee from the Department of Anesthesia of Faculty of Medicine, Al-Azhar University. Patients gave written informed consents. A total of 80 patients undergoing total hip replacement with spinal anesthesia were enrolled in our study. Eligible patients were randomly classified into four groups; 20 patients had received lateral QLB (QLB-1), 20 patients had received posterior QLB (QLB-2), 20 patients had received transmuscular QLB (QLB-3). QL blocks were done using 20 ml of Bupivacaine 0.25 %. The remaining 20 patients had received spinal anaesthesia only (SAB) that served as control group.
Results: The time of requirement of first analgesia significantly prolonged in QLB-3 compared to QLB-1, QLB-2 and SAB control and prolonged in QLB-1 and QLB-2 than SAB control with insignificant differences between QLB1 and QLB-2. The total doses of rescue morphine were significantly lower in QLB-3 compared to QLB-1, QLB-2 and SAB control, and lower in QLB-1 and QLB-2 than SAB control with insignificant differences between QLB1 and QLB-2. VAS was significantly different among the four groups at 2, 12 and 24 hours (P <0.001) but was insignificantly different at PACU and 6 hours. VAS at 2 hours was significantly lower in QLB-3 compared to QLB1, QLB-2 and SAB Control but with insignificant differences among QLB1, QLB-2 and SAB control group. VAS at 12 and 24 hours were significantly lower in QLB-3 compared to QLB-1, QLB-2 and SAB Control and lower in QLB-1 and QLB-2 than SAB Control with insignificant differences between QLB1 and QLB-2.
Conclusion: Ultrasound guided postsurgical transmuscular approach of QLB (QLB-3) using 20 ml
0.25% bupivacaine produces more postoperative analgesic effect and less postoperative opioid
consumption when compared to posterior QLB approach (QLB-2) in patients underwent unilateral
inguinal hernia repair under general anesthesia.
References
2. Wilson SH, Wolf BJ, Algendy AA, Sealy C, Demos HA, McSwain JR. Comparison of lumbar epidurals and lumbar plexus nerve blocks for
analgesia following primary total hip arthroplasty: a retrospective analysis. The Journal of arthroplasty. 2017 Feb 1;32(2):635-40.
3. Suresh S, Ecoffey C, Bosenberg A, Lonnqvist PA, De Oliveira GS, de Leon Casasola O, De Andrés J, Ivani G. The European Society of
Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine recommendations on local anesthetics and adjuvants dosage in pediatric regional anesthesia. Regional Anesthesia & Pain Medicine. 2018 Feb 1;43(2):211-6.
4. Gupta SK, Grewal R, Anne S, Garg A. A comparison of transversus abdominis plane block with quadratus lumborum block for postoperative analgesia in abdominal hysterectomy: a retrospective observational study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2021 May1;10(5):1814-20.
5. 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 doubleblind study. Indian Journal of Anaesthesia. 2020 Oct;64(10):887.
6. Green MS, Hoffman CR, Iqbal U, Ives OO, Hurd B. Transmuscular quadratus lumborum block reduces length of stay in patients receiving total hip arthroplasty. Anesthesiology and Pain Medicine. 2018 Dec;8(6).
7. Hu J, Wang Q, Zeng Y, Xu M, Gong J, Yang J.The impact of ultrasound-guided transmuscular quadratus lumborum block combined with local infiltration analgesia for arthroplasty on postoperative pain relief. Journal of Clinical Anesthesia. 2021 Oct 1; 73:110372.
8. Ahmed, A., Fawzy, M., Nasr, M.A.R. et al.Ultrasound-guided quadratus lumborum block for postoperative pain control in patients undergoing unilateral inguinal hernia repair, a comparative study between two approaches. BMC Anesthesiol19, 184 (2019).
9. He J, Zhang L, He WY, Li DL, Zheng XQ, Liu QX, Wang HB. Ultrasound-guided transmuscular quadratus lumborum block reduces postoperative pain intensity in patients undergoing total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. Pain Research and Management. 2020 Oct;2020.
10. Gutierrez JJ, Ben-David B, Rest C, Grajales MT, Khetarpal SK. Quadratus lumborum block type 3 versus lumbar plexus block in hip replacement surgery: a randomized, prospective, noninferiority study. Regional Anesthesia & Pain Medicine. 2021 Feb 1;46(2):111-7.
11. Hu Z, Zhang Z, Tian X. Efficacy of UltrasoundGuided Quadratus Lumborum Block for Postoperative Analgesia After Hip Arthroplasty: A Meta-Analysis of Randomized Controlled Trials. The Journal of Arthroplasty. 2023 Jan 1;38(1):194-201.
12. Kukreja P, MacBeth L, Sturdivant A, Morgan CJ, Ghanem E, Kalagara H, Chan VW. Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study. Regional Anesthesia & Pain Medicine. 2019 Dec 1;44(12):1075-9.
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