Continuous quadratus lumborum type 3 block provides effective postoperative analgesia for hip surgery: case report

Yayık, Ahmet Murat; Cesur, Sevim; Öztürk, Figen; Ahişkalıoğlu, Ali; Çelik, Erkan

doi:10.1016/j.bjane.2018.07.002

Cited by 7 publications

(3 citation statements)

References 9 publications

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“…10,15 On the other hand, quadriceps weakness is a common problem after the FIB. 16 Motor sparing is generally desirable after joint replacement surgery because it promotes early ambulation of the patients; 17 thus, a better postoperative motor profile is considered an advantage of the QLB over the FIB.…”

Section: Discussionmentioning

confidence: 99%

Transmuscular Quadratus Lumborum Block versus Suprainguinal Fascia Iliaca Block for Hip Arthroplasty: A Randomized, Controlled Pilot Study

Nassar¹,

Hasanin²,

Sewilam³

et al. 2021

LRA

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Background: This study aimed to investigate the analgesic efficacy and motor block profile of single-shot transmuscular quadratus lumborum block (QLB) in comparison with those of suprainguinal fascia iliaca block (FIB) in patients undergoing hip arthroplasty. Methods: This randomized, double-blinded, controlled trial included adult patients undergoing hip arthroplasty under spinal anesthesia. Patients were allocated to one of two groups according to the regional block received: FIB group (n=19) or QLB group (n=17). Both study groups were compared with regard to the duration of analgesia (primary outcome), block performance time, pain during positioning for spinal anesthesia, total morphine consumption in the first postoperative 24-h period, quadriceps muscle power, and static and dynamic visual analog scale. Results: Thirty-six patients were included in the final analysis. Both study groups had comparable durations of analgesia. Postoperative visual analog scale (static and dynamic) values were comparable between the two groups in most readings. The block performance time was shorter in the FIB group. The number of patients with pain during positioning for the subarachnoid block was lower in the QLB group. The total morphine requirement during the first 24 h was marginally lower in the FIB group, whereas the quadriceps motor grade was higher in the FIB group than in the QLB group at 4 h and 6 h after surgery. Conclusion: Both single-shot blocks, namely the suprainguinal FIB and transmuscular QLB, provide effective postoperative analgesia after hip arthroplasty. FIB showed slightly lower 24-h morphine consumption, while QLB showed better quadriceps motor power. Clinical Trial Registration: The study was registered at clinical trials registry system before enrollment of the first participant (NCT04005326; initial release date, 2 July 2019; https://clinicaltrials.gov/ct2/show/NCT04005326).

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Section: Discussionmentioning

confidence: 99%

Transmuscular Quadratus Lumborum Block versus Suprainguinal Fascia Iliaca Block for Hip Arthroplasty: A Randomized, Controlled Pilot Study

Nassar¹,

Hasanin²,

Sewilam³

et al. 2021

LRA

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“…Nevertheless, this study also has some limitations. With reference to the previous literature, this study only used 0.6 ml•kg-10.4% ropivacaine hydrochloride in preoperative nerve block and postoperative continuous infusion of 5 ml•h-1 0.2% ropivacaine hydrochloride [18,21,32], without any observable local anesthetic toxicity. However, since QL block is still in the exploratory stage, there is no consensus regarding optimal drug concentration and volume, and further verification of optimal drug volumes of this study will be necessary.…”

Section: Resultsmentioning

confidence: 99%

Ultrasound Guided Continuous Quadratus Lumborum Block Hastened Recovery in Patients Undergoing Open Liver Resection: A Randomized Controlled, Open-label Trial

Zhu

Yang

et al. 2019

Preprint

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Background Quadratus lumborum (QL) block is increasingly being used as a new abdominal nerve block technique. In some studies of mid and lower abdominal and hip analgesia, continuous QL block achieved favorable outcomes as an alternative to continuous intravenous analgesia with opioids. However, the use of continuous QL block for upper abdominal pain is less well characterized. This study aimed to investigate the effects of continuous anterior QL block (CQLB) on postoperative pain and recovery in patients undergoing open liver resection. Methods Sixty-three patients underwent elective open liver resection were randomly divided into continuous anterior QL block (CQLB, n = 32) group and patient-controlled intravenous analgesia (PCIA, n = 31) group. Patients in CQLB group underwent ultrasound-guided anterior QL block at the second lumbar vertebral transverse processes before general anesthesia, followed by postoperative CQLB analgesia. Patients in PCIA group underwent continuous intravenous analgesia postoperatively. Postoperative numerical rating scale (NRS) pain scores upon coughing and at rest, self-administered analgesic counts, rate of rescue analgesic use, time to first out-of-bed activity and anal flatus after surgery, and incidences of analgesic-related adverse effects were recorded. Results Postoperative NRS pain scores on coughing in CQLB group at different time points and NRS pain score at rest 48 h after surgery were significantly lower than those in PCIA group (P <0.05). Time to first out-of-bed activity and anal flatus after surgery in CQLB group were significantly earlier than those in PCIA group (P <0.05). No significant differences of postoperative self-administered analgesic counts, rate of postoperative rescue analgesic usage, or incidences of analgesic-related adverse effects were found between the two groups (P >0.05). Conclusions Ultrasound-guided anterior QL block significantly alleviated the pain during coughing after surgery, shortened the time to first out-of-bed activity and anal flatus, promoting postoperative recovery of the patients undergoing open liver resection.

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“…e fascia iliaca block is also relatively easy to perform, but as with the femoral nerve block, quadriceps weakness is a known side effect if done using an infrainguinal approach [3]. Depending on the approach, the quadratus lumborum block can successfully provide a sensory block between T6-L3 without causing motor weakness (which can occur with the injection of local anesthetic via the anterior approach) [3,[12][13][14][15]. In comparison to the aforementioned blocks, the ESPB seems to be the only block to provide analgesia without documented motor blockade of the quadriceps muscles.…”

Section: Discussionmentioning

confidence: 99%

Lumbar Erector Spinae Plane Block for Total Hip Arthroplasty Comparing 24-Hour Opioid Requirements: A Randomized Controlled Study

Townsend

Siddique

Kimura

et al. 2022

Anesthesiology Research and Practice

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Study Objective. Neuraxial and regional anesthesia have become commonly utilized for patients undergoing total hip arthroplasty to aid in postoperative analgesia, facilitating early ambulation and better functional recovery. This study investigated the efficacy of a lumbar erector spinae plane block (ESPB) on reducing postoperative opioid consumption in total hip arthroplasty performed under spinal anesthesia. Design. Prospective, randomized, controlled trial. Patients. Sixty-three adult patients with an American Society of Anesthesiologists Status I–III who are undergoing elective primary total hip arthroplasty. Interventions. Patients were randomized to the control group (no block) or the ESPB group (preoperative ultrasound-guided lumbar ESPB). Intraoperatively, all patients received spinal anesthesia with moderate sedation. Postoperatively, patients received a standardized multimodal analgesia protocol. Measurements. The primary outcome was cumulative opioid consumption at 24 hours postoperatively. Secondary outcomes included cumulative opioid consumption at 8 hours and through 48 hours postoperatively and pain scores at 24 and 48 hours post surgery. Main Results. Thirty-one patients were randomized to the control group (spinal alone) and 32 patients to the ESPB group. The median opioid requirement in the first 8 hours after surgery was higher in the control group (28 mg of oral morphine equivalents (OME) versus 5 mg of OME in the ESPB group) ( p = 0.013 ). There was no statistically significant difference in opioid consumption between the groups at 24 hours ( p = 0.153 ) or 48 hours ( p = 0.357 ) postoperatively. There was no statistically significant difference in pain scores between the two groups through 24 hours ( p = 0.143 ) or 48 hours ( p = 0.617 ) after surgery. Conclusion. Lumbar ESPB reduces opioid utilization during the first 8 hours postoperatively after total hip arthroplasty but not thereafter. Evaluating the use of either adding a local anesthetic adjunct to the ESPB or using longer-acting local anesthetic warrants further investigation.

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Continuous quadratus lumborum type 3 block provides effective postoperative analgesia for hip surgery: case report

Cited by 7 publications

References 9 publications

Transmuscular Quadratus Lumborum Block versus Suprainguinal Fascia Iliaca Block for Hip Arthroplasty: A Randomized, Controlled Pilot Study

Transmuscular Quadratus Lumborum Block versus Suprainguinal Fascia Iliaca Block for Hip Arthroplasty: A Randomized, Controlled Pilot Study

Ultrasound Guided Continuous Quadratus Lumborum Block Hastened Recovery in Patients Undergoing Open Liver Resection: A Randomized Controlled, Open-label Trial

Lumbar Erector Spinae Plane Block for Total Hip Arthroplasty Comparing 24-Hour Opioid Requirements: A Randomized Controlled Study

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