Ultrasound-Guided Anterior Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Related Side Effects in Patients Undergoing Total Hip Replacement Arthroplasty: A Propensity Score-Matched Cohort Study.

Yeon-Ju Kim,Sun-Hyung Lee,Ji-In Park,Young-Jin Ro,Pil-Whan Yoon,Ha-Jung Kim,Won-Uk Koh,Hyung-Tae Kim

doi:10.3390/jcm10204632

Yeon-Ju Kim, Sun-Hyung Lee + Show 6 more

Open Access

https://doi.org/10.3390/jcm10204632

Copy DOI

Abstract

Quadratus lumborum block (QLB) has been shown to be effective for pain relief after hip surgery. This study evaluated the efficacy of ultrasound-guided anterior QLB in pain control after total replacement hip arthroplasty (TRHA). A total of 115 patients receiving anterior QLB were propensity score-matched with 115 patients who did not receive the block. The primary outcome was opioid consumption at 24, 24–48, and 48 postoperative hours. Secondary outcomes included pain scores at the post-anesthesia care unit (PACU), 8, 16, 24, 32, 40, and 48 h length of hospital stay, time to first ambulation, and the incidence of opioid-related side effects. Postoperative opioid consumption 48 h after surgery was significantly lower in the QLB group. Resting, mean, worst, and the difference of resting pain scores compared with preoperative values were significantly lower in the QLB group during the 48 postoperative hours. The length of hospital stay was shorter in the QLB group. The incidence of postoperative nausea and vomiting was significantly lower in the QLB group during the 48 postoperative hours, except at the PACU. This study suggests that anterior QLB provides effective postoperative analgesia for patients undergoing THRA performed using the posterolateral approach.

Highlights

Total hip replacement arthroplasty (THRA) has been shown to improve long-term quality of life, it can cause moderate to severe perioperative pain [1]
Peripheral nerve blocks are known to cause fewer serious side effects than epidural anesthesia [4]; several techniques such as femoral nerve block or lumbar plexus block have been introduced as possible alternatives of epidural analgesia for pain control after THRA [5]
The exclusion criteria included patients with chronic pain or daily opioid consumption before surgery exceeding that of chronic opioid users, patients who were transferred to the intensive care unit (ICU) after surgery or remained sedated, emergency surgeries, revision surgeries, patients who did not receive intravenous patientcontrolled analgesia (IV PCA), and patients with incomplete medical records

Summary

Introduction

Total hip replacement arthroplasty (THRA) has been shown to improve long-term quality of life, it can cause moderate to severe perioperative pain [1]. Adequate postoperative analgesia is important because it has been associated with increased patient satisfaction, earlier mobilization, and decreased length of hospital stay. Perioperative pain has been managed by epidural analgesia, parenteral opioids, and peripheral nerve blocks. Epidural analgesia is efficacious [2], it is generally difficult to apply because of its side effects and rare but major complications [3]. Peripheral nerve blocks are known to cause fewer serious side effects than epidural anesthesia [4]; several techniques such as femoral nerve block or lumbar plexus block have been introduced as possible alternatives of epidural analgesia for pain control after THRA [5]. Optimal regional analgesic intervention for THRA is yet to be defined because innervation of the hip joint is complex and preservation of lower extremity motor function is further needed for early mobilization and prompt recovery in current practice guidelines [6]

Objectives

Methods

Results

Discussion

Conclusion