Clinical effect of quadratus lumborum block guided by ultrasound combined with nalbuphine on postoperative analgesia in elderly patients undergoing total hip arthroplasty

Abstract

Objective To investigate the clinical efficacy of quadratus lumborum block guided by ultrasound combined with nalbuphine for postoperative analgesia in elderly patients undergoing total hip arthroplasty. Methods One hundred and twenty 65-80 ears old patients, scheduled for total hip arthroplasty, were randomly divided into a control group (group C) and a quadratus lumborum block (group Q)two groups using random number table method, 60 for each group. Both groups took spinal-epidural anesthesia. Group Q took quadratus lemborum block guided by ultrasound within 30 min after operation and were injected 30 ml 0.33% ropivacaine. Then sufentanil patient-controlled analgesia pumpd were connected to all the patients in both groups. Multimodal analgesia was performed by nalbuphine 5 mg iv and quadratus lumborum block every 24 h after operation for 48 h. The rest and active exercise visual analogue scale (VAS) scores were recorded when the surgery was over (T0) and 3 (T1), 6 (T2), 12 (T3), 24 (T4), 36 (T5), and 48 h (T6) after operation. The number of cases who needed remedial analgesia by PCIA was determined. The development of adverse reactions during blockade and overall satisfaction were recorded in the two groups. Results Compared with group C, the rest VAS scores at T1-T6 and active exercise VAS scores at T4-T6 were significantly lower (P<0.05) in group Q. Compared with C group, fewer cases needed remedial analgesia by PCIA (P<0.05) in Q group (56 cases vs. 6 cases, 57 cases vs. 10 cases, and 57 cases vs. 10 cases). Compared with group C, the incidences of nausea and vomiting and pruritus were lower (P<0.05, 23.3% vs. 3.3% and 20.0% vs. 3.3%) but the overall satisfaction score was higher (P<0.05) in Q group (98.3% vs. 80.0%). Conclusion Multimodal analgesia constituted of quadratus lumborum block guided by ultrasound combined with nalbuphine iss effective and provides satisfactory postoperative analgesia in elderly patients undergoing total hip arthroplasty. Key words: Quadratus lumborum block; Ultrasound guided; Nalbuphine; Multimodal analgesia; Total hip arthroplasty; Elderly patients