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The impact of ultrasound-guided transmuscular quadratus lumborum block combined with local infiltration analgesia for arthroplasty on postoperative pain relief - 14/06/21

Doi : 10.1016/j.jclinane.2021.110372 
Jian Hu, MM a, 1, Qiuru Wang, MD b, 1, Yan Zeng, MM a, Min Xu, MM a, Jingxuan Gong, BS Candidate c, Jing Yang, MD a,
a Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041, China 
b Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041, China 
c Department of Biomedical Engineering, Northwestern University, 633 Clark Street, Evanston 60201, IL, USA 

Corresponding author at: Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041, Sichuan, China.Department of AnesthesiologyWest China HospitalSichuan UniversityNo. 37 Wainan Guoxue RoadChengduSichuan610041China

Abstract

Study objective

This study aimed to evaluate the efficacy of ultrasound-guided transmuscular quadratus lumborum block (QLB) combined with local infiltration analgesia (LIA) for pain management and recovery in patients who have undergone total hip arthroplasty (THA) via a posterolateral approach.

Design

This was a prospective, randomized controlled trial.

Setting

We collected data in the preoperative area, operating room, and bed ward.

Patients

A total of 80 patients with American Society of Anesthesiology functional status scores of II-III were included and assigned to two groups, and all 80 patients were included in the final analysis.

Interventions

All included patients were randomly assigned to the nerve block (group N) or the control group (group C). Patients in the group N received transmuscular QLB combined with LIA, while patients in the group C received only LIA.

Measurements

The primary outcome was postoperative pain during the first active motion: it was measured at six hours after surgery and assessed using a visual analog scale (VAS). Secondary outcomes were the resting VAS scores in the post-anesthesia care unit (PACU) and at 2, 6, 12, 24, 48, and 72 h after surgery; VAS scores during motion at 12, 24, 48, and 72 h after surgery; intraoperative consumption of opioids; postoperative consumption of morphine hydrochloride; frequency of sleep interruption due to pain on the night of surgery; time until the first “walk out of the bed” after surgery; muscle strength of the quadriceps femoris; and postoperative adverse effects.

Main results

Compared to the group C, patients in the group N had significantly lower VAS scores during motion at 6, 12, and 24 h after surgery, as well as lower resting VAS scores in the PACU and at 2, 6, 12, and 24 h after surgery. Patients in the group N also consumed significantly smaller amounts of intraoperative opioids and morphine after surgery. Patients in the group N reported significantly fewer interruptions in sleep due to pain on the night of surgery and were able to “walk out of the bed” significantly earlier than those in the group C. There was no significant difference between the two groups in muscle strength of the quadriceps femoris or incidence of postoperative adverse effects.

Conclusions

Compared to treatment with LIA alone, ultrasound-guided transmuscular QLB combined with LIA can provide better postoperative pain relief and enhance the recovery of THA patients, since it does not cause quadriceps femoris muscle weakness and is associated with significantly lower need for intraoperative opioids.

Le texte complet de cet article est disponible en PDF.

Highlights

The well-established method of LIA can be further optimized by combining ultrasound-guided transmuscular QLB.
Ultrasound-guided transmuscular QLB combined with LIA can enhance the recovery of patients undergoing THA.
The combination of transmuscular QLB and LIA can be recommend as the primary method in enhanced recovery THA protocols.

Le texte complet de cet article est disponible en PDF.

Keywords : Total hip arthroplasty, Quadratus lumborum block, Local infiltration analgesia, Pain, Recovery


Plan


 This study was performed at the West China Hospital, Sichuan University.


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Vol 73

Article 110372- octobre 2021 Retour au numéro
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