Ultrasound Guided Quadratus Lumborum Block for Post-Operative Analgesia in Patients Undergoing Total Hip Arthroplasty: A Prospective, Double Blind, Placebo Controlled Study
Abstract
Background: Primary objective:
- Duration of block
- Post-operative pain score
- Post-operative rescue analgesic consumption
Secondary objective:
- To observe patient satisfaction score
- Occurrence of post-operative complications if any.
Methods: A total of 60 patients, aged between 18-60yrs, belonging to ASA I & II with hip osteoarthritis requiring total hip arthroplasty (THA) were divided into two groups of 30 each. Patients were randomized into two groups and were given ipsilateral USG guided anterior QLB in the fascial plane between QL and psoas major muscles after surgery. Group C received 30ml NS and group T received 30ml of inj. Ropivacaine 0.2%. Post operatively patient received inj. PCM 1G TDS. Duration of block, requirement of rescue analgesia, VAS score and side effects were the parameters those were monitored and compared.
Results: Mode pain score by VAS was significantly lower in T group(p<0.05) than C group which required more analgesia. (The chi-square value-5.9341, p=0.0148). Duration of block was more in T group. Patient satisfaction was noted to be better in T group.
Conclusion: Use of post-operative USG guided Ant. QLB reduced VAS score in patient undergoing THA. It also significantly decreased the requirement of post- operative rescue analgesia and improved patient satisfaction.
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[2] 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(10):887-893.
[3] Ueshima H, Yoshiyama S, Otake H. The ultrasound-guided continuous transmuscular quadratus lumborum block is an effective analgesia for total hip arthroplasty. J Clin Anesth. 2016; 31:35.
[4] Kadam VR, Howell S. Ultrasound-guided continuous transmuscular quadratus lumborum block- L4 or L2 level catheter insertion for analgesia in open abdominal surgery: Case series. Indian J Anaesth. 2018; 62:555-7.
[5] Kukreja P, MacBeth L, Sturdivant A, Morgan CJ, Ghanem E, Kalagara H, et al. Anterior quadratus lumborum block analgesia for total hip arthroplasty: A randomized, controlled study. Reg Anesth Pain Med. 2019; 44:1-5. 29.
[6] Kukreja P, MacBeth L, Potter W, Buddemeyer K, DeBell H, Elsharkawy H, et al. Posterior quadratus lumborum block for primary total hip arthroplasty analgesia: A comparative study. Einstein (São Paulo) 2019; 17:eA04905.
[7] Bendtsen T.F. Kølsen J.A.P. Regional analgesi.in: Rasmussen L.S. Steinmetz J. Anæstesi. 4th Edn. FADL’s Forlag, København2014: 143-172
[8] Blanco R. TAP block under ultrasound guidance: The description of a ‘non pops technique’. Reg Anaesth Pain Med. 2007; 32:13020;64:887-93.
[9] Ljungqvist O, Scott M, Fearon KC. enhanced recovery after surgery: A review. JAMA Surg. 2017; 152:292-8.
[10] Nair A. Bilateral quadratus lumborum block for post-caesarean analgesia. Indian J Anaesth. 2017; 61:362-3.
[11] Akerman M, Pejčić N, Veličković I. A review of the quadratus lumborum block and ERAS. Front Med (Lausanne). 2018; 5:44.
[12] Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty. 2007; 22(6 Suppl 2):33-8.
[13] Højer Karlsen AP, Geisler A, Petersen PL, Mathiesen O, Dahl JB. Postoperative pain treatment after total hip arthroplasty: a systematic review. Pain. 2015; 156(1):8-30.
[14] Carline L, McLeod GA, Lamb C. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks. Br J Anaesth. 2016; 117(3):387-94.
[15] Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol. 2013; 29(4):550-2.
[16] La Colla L, Uskova A, Ben-David B. Single-shot Quadratus Lumborum Block for Postoperative Analgesia After Minimally Invasive Hip Arthroplasty: A New Alternative to Continuous Lumbar Plexus Block? Reg Anesth Pain Med. 2017; 42(1):125-126.
[17] Ueshima H, Yoshiyama S, Otake H. Retraction notice to "The ultrasound-guided continuous transmuscular quadratus lumborum block is effective analgesia for the total hip arthroplasty" [J. Clin. Anesth. 31(2016) 35-35]. J Clin Anesth. 2022; 79:110704.
[18] Jadon A, Motka M, Pati AK, Sinha N. Postoperative analgesia by transmuscular quadratus lumborum block catheters. Journal of Anesthesia & Intensive Care Medicine. 2016; 1(3):1-3.
[19] Parras T, Blanco R. Randomised trial comparing the transversus abdominis plane block posterior approach or quadratus lumborum block type I with femoral block for postoperative analgesia in femoral neck fracture, both ultrasound-guided. Rev Esp Anestesiol Reanim. 2016; 63(3):141-8.
[20] Lu Y, Zhang J, Xu X, Chen W, Zhang S, Zheng H, et al. Sensory assessment and block duration of transmuscular quadratus lumborum block at L2 versus L4 in volunteers: a randomized controlled trial. Minerva Anestesiol. 2019; 85(12):1273-1280.
[21] Kukreja P, Macbeth L, Sturdivant A, et al. Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study. Reg Anesth Pain Med. 2019.
[2] 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(10):887-893.
[3] Ueshima H, Yoshiyama S, Otake H. The ultrasound-guided continuous transmuscular quadratus lumborum block is an effective analgesia for total hip arthroplasty. J Clin Anesth. 2016; 31:35.
[4] Kadam VR, Howell S. Ultrasound-guided continuous transmuscular quadratus lumborum block- L4 or L2 level catheter insertion for analgesia in open abdominal surgery: Case series. Indian J Anaesth. 2018; 62:555-7.
[5] Kukreja P, MacBeth L, Sturdivant A, Morgan CJ, Ghanem E, Kalagara H, et al. Anterior quadratus lumborum block analgesia for total hip arthroplasty: A randomized, controlled study. Reg Anesth Pain Med. 2019; 44:1-5. 29.
[6] Kukreja P, MacBeth L, Potter W, Buddemeyer K, DeBell H, Elsharkawy H, et al. Posterior quadratus lumborum block for primary total hip arthroplasty analgesia: A comparative study. Einstein (São Paulo) 2019; 17:eA04905.
[7] Bendtsen T.F. Kølsen J.A.P. Regional analgesi.in: Rasmussen L.S. Steinmetz J. Anæstesi. 4th Edn. FADL’s Forlag, København2014: 143-172
[8] Blanco R. TAP block under ultrasound guidance: The description of a ‘non pops technique’. Reg Anaesth Pain Med. 2007; 32:13020;64:887-93.
[9] Ljungqvist O, Scott M, Fearon KC. enhanced recovery after surgery: A review. JAMA Surg. 2017; 152:292-8.
[10] Nair A. Bilateral quadratus lumborum block for post-caesarean analgesia. Indian J Anaesth. 2017; 61:362-3.
[11] Akerman M, Pejčić N, Veličković I. A review of the quadratus lumborum block and ERAS. Front Med (Lausanne). 2018; 5:44.
[12] Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty. 2007; 22(6 Suppl 2):33-8.
[13] Højer Karlsen AP, Geisler A, Petersen PL, Mathiesen O, Dahl JB. Postoperative pain treatment after total hip arthroplasty: a systematic review. Pain. 2015; 156(1):8-30.
[14] Carline L, McLeod GA, Lamb C. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks. Br J Anaesth. 2016; 117(3):387-94.
[15] Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol. 2013; 29(4):550-2.
[16] La Colla L, Uskova A, Ben-David B. Single-shot Quadratus Lumborum Block for Postoperative Analgesia After Minimally Invasive Hip Arthroplasty: A New Alternative to Continuous Lumbar Plexus Block? Reg Anesth Pain Med. 2017; 42(1):125-126.
[17] Ueshima H, Yoshiyama S, Otake H. Retraction notice to "The ultrasound-guided continuous transmuscular quadratus lumborum block is effective analgesia for the total hip arthroplasty" [J. Clin. Anesth. 31(2016) 35-35]. J Clin Anesth. 2022; 79:110704.
[18] Jadon A, Motka M, Pati AK, Sinha N. Postoperative analgesia by transmuscular quadratus lumborum block catheters. Journal of Anesthesia & Intensive Care Medicine. 2016; 1(3):1-3.
[19] Parras T, Blanco R. Randomised trial comparing the transversus abdominis plane block posterior approach or quadratus lumborum block type I with femoral block for postoperative analgesia in femoral neck fracture, both ultrasound-guided. Rev Esp Anestesiol Reanim. 2016; 63(3):141-8.
[20] Lu Y, Zhang J, Xu X, Chen W, Zhang S, Zheng H, et al. Sensory assessment and block duration of transmuscular quadratus lumborum block at L2 versus L4 in volunteers: a randomized controlled trial. Minerva Anestesiol. 2019; 85(12):1273-1280.
[21] Kukreja P, Macbeth L, Sturdivant A, et al. Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study. Reg Anesth Pain Med. 2019.
| Files | ||
| Issue | Vol 9 No 3 (2023): Summer |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v9i3.13112 | |
| Keywords | ||
| Ultrasonography Total hip arthroplasty Post-op analgesia Quadratus lumborum block Type3 | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Acharya S, Acharya G, Rawekar S. Ultrasound Guided Quadratus Lumborum Block for Post-Operative Analgesia in Patients Undergoing Total Hip Arthroplasty: A Prospective, Double Blind, Placebo Controlled Study. Arch Anesth & Crit Care. 2023;9(3):195-200.
