Transmuscular Quadratus Lumborum Block Reduces Length of Stay in Patients Receiving Total Hip Arthroplasty

Abstract

BackgroundTotal 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.MethodsTwenty 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).ResultsLength 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.ConclusionsQL 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.

Efficacy of transmuscular quadratus lumborum block in the multimodal regimen for postoperative analgesia after total laparoscopic hysterectomy: A prospective randomised double-blinded study

“…Initially it was observed as a complication and later used as anaesthetic technique to provide analgesia in lower limb surgery. [ 3 22 23 ] However, we did not find any sensory loss or motor weakness in the lower limbs as reported in other studies. The spread of local anaesthetic over lumbar plexus leading to sensory changes and motor weakness of lower limb is decided by the position of needle during block.…”

“…If block needle pierces the fascia of psoas muscle, the chances of motor weakness increases due to involvement of the lumbar plexus. [ 3 22 23 ] In our block technique, we were cautious to avoid the puncture of the psoas muscle fascia. However, this is just an assumption and may require further studies focussed on this particular aspect.…”

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

“…However, the post-operative pain score lacked statistical significance, which may be due to the use of general anaesthesia in all patients and the small sample size. [ 30 ]…”

To evaluate the effect of quadratus lumborum block on the tramadol sparing effect in patients undergoing open inguinal hernia surgery: A randomised controlled trial

“…The intra-operative use of fentanyl was also lower in patients receiving QL block (183.5 μg) versus patients not receiving QL block (240 μg) (p value = 0.038). [ 25 ] Diwan et al . in a case series of five patients described contrast spread in high and low QLB with the initial needle placement at upper-mid or mid-lower part of the kidney.…”