Abstract
Methods Eighty-eight patients undergoing THA were randomized to receive 0.33% ropivacaine (Group QLB, n = 44) or saline (Group Con, n = 44) for QL3 block. Spinal anesthesia was then performed. Pain intensity was assessed using the visual analog scale (0: no pain to 10: worst possible pain). The primary outcome was pain scores recorded at rest at 3, 6, 12, 24, 36, and 48 h and on standing and walking at 24, 36, and 48 h postoperatively. Secondary outcomes were analgesic consumption, side effects, the 10-meter walking speed on day 6, and patient satisfaction after surgery. Results Postoperative pain intensity was significantly lower in Group QLB compared to Group Con at rest after 3, 6, 12, 24, 36, and 48 h (p < 0.001) and during mobilization after 24, 36, and 48 h (p < 0.001). Morphine use was significantly lower in Group QLB compared to Group Con during 0–24 h (16.0 ± 7.1 vs. 34.1 ± 7.1 mg, p < 0.001) and during 24–48 h (13.0 ± 4.0 vs. 17.4 ± 4.6 mg, p < 0.001) postoperatively. The 10-meter walking speed was higher in Group QLB compared to Group Con, both at comfortable (0.79 ± 0.13 vs. 0.70 ± 0.14 m/s, p=0.012) and at maximum speeds (1.18 ± 0.26 vs. 1.06 ± 0.22 m/s, p < 0.001). Incidences of nausea (7.3% vs. 31%, p=0.006), vomiting (7.3% vs. 26.2%, p = 0.022), and urinary retention (9.8% vs. 28.6%, p=0.030) were lower in Group QLB than in Group Con. Conclusions Ultrasound-guided QL3 block is an effective pain management technique after THA.
Highlights
Many patients with total hip arthroplasty (THA) experience moderate to severe acute pain in the early postoperative period [1]
Patients in Group QLB had significantly lower visual analog scale (VAS) scores at rest at 3, 6, 12, 24, 36, and 48 h after surgery compared to Group Con (p < 0.001)
Patients in Group QLB had lower pain scores during mobilization at 24, 36, and 48 h compared to Group Con (p < 0.001)
Summary
Many patients with total hip arthroplasty (THA) experience moderate to severe acute pain in the early postoperative period [1]. Ere are many methods to manage postoperative pain following THA, including the use of opioids and nonsteroidal anti-inflammatory drugs, local infiltration analgesia, patient-controlled analgesia, and peripheral nerve blocks (PNBs) [4]. Single nerve blocks may have poor analgesic effects in THA, and the lumbar plexus block may be an ideal PNB for postoperative pain control following THA. Case reports, by themselves, do not have enough data to draw conclusions We designed this prospective, randomized, double-blind, placebo-controlled trial to investigate whether the QL3 block can be used for analgesia after THA. E aim of this placebo-controlled trial was to investigate the effects of the QL3 block on pain intensity, opioid requirement, and mobilization in patients undergoing THA. We hypothesized that the QL3 block would reduce pain intensity and opioid requirements in patients following THA
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