A Comparative Analysis of the Quadratus Lumborum Block Versus Femoral Nerve and Fascia Iliaca Blocks in Hip Arthroscopy

Blackwell, Roger D.; Kushelev, Michael; Norton, John A.; Pettit, Robert; Vasileff, W Kelton

doi:10.1016/j.asmr.2020.08.002

“…Moreover, anterior QLB provides analgesia from T10 to L4 nerve roots with good cephalic spread better than LPB in a study on cadavers using dye injections [ 36 ]. Ryan et al demonstrated that QLB was superior to femoral nerve and fascia iliaca blocks in decreasing opioid consumption perioperatively, providing better pain scores, and decreasing discharge time after hip arthroscopy [ 37 ]. However, Brixel et al pointed out that the sensory blockade associated with QLB was frequently patchy and does not correspond to a classic dermatomal distribution [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study between Postoperative Analgesia of Fascia Iliaca Compartment Block and Anterior Quadratus Lumborum Block in Proximal Femur Fracture

Elmaksoud

¹

,

Elansary

²

,

Fahmy

³

et al. 2022

Anesthesiology Research and Practice

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Elderly patients with various comorbidities are more likely to suffer from proximal femur fractures. It is also a painful fracture, and poor pain management can have serious physiological and psychological consequences, such as acute delirium. Purpose. The aim of this study is to compare the efficacy of ultrasound-guided transmuscular (anterior) quadratus lumborum block (QLB) versus infrainguinal fascia iliaca compartment block (FICB) in proximal femur fractures for postoperative analgesia. Patient-reported pain on the visual analogue scale (VAS), analgesic demand, and ambulation were the key factors. Patients and Methods. This prospective, randomised trial was done after receiving approval from the institute’ study ethical committee. In this study, ultrasound-guided infrainguinal fascia iliaca compartment block was compared to ultrasound-guided anterior quadratus lumborum block using 50 ml of bupivacaine 0.25%, with a maximum dose of 2.5 mg/kg at the end of surgery after spinal anaesthesia in 128 patients (64 patients in each group). Nalbuphine was given as rescue analgesia if VAS >3. Our 1st outcome was the first rescue analgesia and total analgesic consumption in the 1st 24 hours; the 2nd outcome was the time patients started to ambulate. Results. Postoperative pain perception was substantially greater in the FICB group starting from 30 min (P value 0.022) till 24 hours ( P value <0.001), and they received a considerably larger total narcotic dose (14.1 ± 3.5) than patients in the QLB group (7.9 ± 3.4), P value (<0.001 ∗ ). The time required to achieve first rescue analgesia was much less in the FICB group (8.5 ± 2.2) compared to the QLB group (14.1 ± 4.5), P value (<0.001 ∗ ), and they took much longer to ambulate (22.3 ± 4.8) when compared to the QLB group (20.1 ± 4.6), P value (0.011 ∗ ). Hypotension (1.6%) was detected mainly in the QLB group, whereas poor fascial separation (1.6%) was observed only in the FICB group. There were no significant differences in complications between both the FICB and QLB groups. Conclusion. Patients receiving postoperative anterior QL block for proximal femur fracture demonstrated delayed first rescue analgesia and lower total nalbuphine consumption with early ambulation than patients who received FICB.

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“…5 A retrospective study comparing TQLB, FNB, and FIB in patients undergoing hip arthroscopies concluded that TQL group had lower total opioid requirements and lower pain scores at discharge than patients receiving preoperative FIB/FNB blocks. 6 Among the different versions of QLB the transmuscular quadratus lumborum (TQL) nerve block, owing to its spread to lumbar nerve roots and thoracic paravertebral space, has been shown to provide effective and long-lasting analgesia in a wide range of lower abdominal and pelvic surgeries involving T4-L1 sensory levels. 7 We therefore tested the primary hypothesis that a single injection TQL block will significantly reduce cumulative morphine consumption in the initial postoperative period and may be an effective alternative to FIB.…”

Section: Introductionmentioning

confidence: 99%

Transmuscular Quadratus Lumborum Block versus Infrainguinal Fascia Iliaca Nerve Block for Patients Undergoing Elective Hip Replacement: A Double-blinded, Pilot, Randomized Controlled Trial

Hashmi¹,

Cusack²,

Hughes³

et al. 2022

LRA

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Purpose Transmuscular quadratus lumborum (TQL) block has been described as an effective option for postoperative analgesia in patients undergoing hip replacement with single injection described as providing analgesia for up to 24 h. We hypothesize that a TQL block, when compared to fascia iliaca block (FIB), will provide better analgesia and less motor block in the initial 24-h postoperative period. Patients and Methods Fifty patients undergoing elective hip replacement surgery, ASA I–III, were included in the study. Patients were randomized into two groups. Patients in group A received spinal anesthesia followed by FIB. Patients in group B received spinal anesthesia followed by TQLB. Postoperative pain scores and motor block were assessed at 6 and 24 hours. The primary outcome measure was 24 h total morphine consumption. Secondary outcome measures included pain score (VNS) and motor block (modified Bromage scale) at 6 and 24 h postoperatively. Results There was no statistical difference in morphine consumption between the two groups ( p -value 0.699). There was no difference in pain scores at 6 h ( p -value 0.540) or 24 h ( p -value 0.383). There was no difference in motor block at 6 h ( p- value 0.497) or at 24 h ( p -value 0.773). Conclusion Transmuscular quadratus lumborum block along with spinal anesthesia for patients undergoing elective hip replacement surgery does not reduce opioid consumption or motor weakness when compared to fascia iliaca block. The results and conclusion apply to a dose of 20 mL of 0.25% bupivacaine used in each group.

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“…Preoperatively nerve block was applied in 13 studies [ 4 – 6 , 14 – 18 , 20 – 24 ], and postoperative nerve block was used in 1 study [ 19 ]. 5 studies [ 6 , 16 , 20 , 22 , 23 ] employed the general anesthesia, 4 studies [ 4 , 5 , 14 , 19 ] used regional anesthesia, and 5 studies [ 15 , 17 , 18 , 21 , 24 ] did not mention the detailed method of anesthesia. Fentanyl was used for standard general anesthesia.…”

Section: Resultsmentioning

confidence: 99%

“…There were four trials that reported details of narcotic consumption [ 18 , 20 , 22 , 23 ]. In the meta-analysis, a significant heterogeneity was found ( P < 0.05), and no significant differences were shown in the FNB groups compared with the FICB group in reducing narcotic consumption at 24 h (MD = 0.45, 95% CI: −0.30 to 1.20, P = 0.24 Figure 4 ).…”

Section: Outcomes For Meta-analysismentioning

confidence: 99%

Is Femoral Nerve Block Superior to Fascia Iliac Block in Hip Surgery? Meta-Analysis of Randomized Controlled Trials

Li

¹

,

Han

²

,

Yu

³

2022

BioMed Research International

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Background. Femoral nerve block (FNB) and fascia iliac compartment block (FICB) are alternative methods of pain relief during hip surgery. Nevertheless, the effectiveness and safety of FNB compared with FICB are yet to be fully determined. Methods. Electronic databases were systematically searched. Only randomized controlled trials (RCTs) on hip surgery were included. Postoperatively, the pain scores at different time points, narcotic requirements in 24 h, mean arterial pressure, spinal anesthesia (SA) time, patient satisfaction, and adverse effect rates between the two groups were extracted throughout the study. Results. Fourteen RCTs including 1179 patients were included. Compared to the FICB, FNB decreased the VAS scores postoperatively at 24 h at rest ( P < 0.05 ) and the incidence rate of some side effects (nausea, vomiting, and sedation) ( P < 0.05 ). However, compared to the FICB, no significant difference was found in the FNB regarding the VAS scores postoperatively at any of the other time points (2 min, 20 min, 2 h, 24 h at movement, 48 h at rest, and 48 h at movement). Patients in both groups had similar narcotic needs after 24 h, mean arterial pressure, SA time, and patient satisfaction ( P > 0.05 ). Conclusions. FNB has more advantages in reducing VAS scores postoperatively at 24 h at rest and the odds of some adverse effects. A better quality RCT is needed to properly compare FNB with FICB.

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A Comparative Analysis of the Quadratus Lumborum Block Versus Femoral Nerve and Fascia Iliaca Blocks in Hip Arthroscopy

Cited by 18 publications

References 33 publications

A Comparative Study between Postoperative Analgesia of Fascia Iliaca Compartment Block and Anterior Quadratus Lumborum Block in Proximal Femur Fracture

A Comparative Study between Postoperative Analgesia of Fascia Iliaca Compartment Block and Anterior Quadratus Lumborum Block in Proximal Femur Fracture

Transmuscular Quadratus Lumborum Block versus Infrainguinal Fascia Iliaca Nerve Block for Patients Undergoing Elective Hip Replacement: A Double-blinded, Pilot, Randomized Controlled Trial

Is Femoral Nerve Block Superior to Fascia Iliac Block in Hip Surgery? Meta-Analysis of Randomized Controlled Trials

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