Comparison Between Ultrasound-Guided Suprainguinal Fascia Iliaca Block and Anterior Quadratus Lumborum Block for Total Hip Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Trial

Wang, Qiuru; Hu, Jian; Zhang, Wanli; Zeng, Yan; Yang, Jing; Kang, Pengde

doi:10.1016/j.arth.2022.01.011

Cited by 21 publications

(35 citation statements)

References 34 publications

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“…Patients randomized to lateral QLBs had greater quadricep strength in PACU and were almost 2.4 times more likely to ambulate in the first 12 hours after surgery. While the few RCTs examining motor function have not noted quadricep strength to be decreased by QLBs compared with placebo after hip surgery8 22 or have shown improved strength when compared with LPB13 or fascia iliac block23 24 weakness was reported in one publication in 30% of subjects following an anterior QLB 25. This weakness may result from injectate spread to the lumbar paravertebral space and lumbar plexus,15 and this was another reason we examined the lateral QLB over the anterior QLB approach.…”

Section: Discussionmentioning

confidence: 99%

Comparison of lateral quadratus lumborum and lumbar plexus blocks for postoperative analgesia following total hip arthroplasty: a randomized clinical trial

Kelly

Wolla

Hay

et al. 2022

Reg Anesth Pain Med

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IntroductionEffective analgesia after total hip arthroplasty must minimize pain and optimize early ambulation. Lumbar plexus blocks (LPBs) provide analgesia but may cause motor weakness. Quadratus lumborum blocks (QLBs) may provide analgesia with preserved motor strength.MethodsThis trial randomized subjects scheduled for elective hip arthroplasty to receive an LPB or lateral QLB for postoperative analgesia. The primary outcome was opioid consumption at 12-hour postoperative. Non-inferiority of lateral QLBs compared with LPBs was conducted using a one-sided two-sample t-test. Secondary outcomes included pain scores, cumulative opioid consumption, quadriceps strength, time to ambulation, and distance ambulated. Differences in pain scores and opioid consumption over time between groups were evaluated using a linear mixed model.ResultsThe trial consented and randomized 111 subjects and 103 completed the study: LPB (n=50) and lateral QLB (n=53). Mean (95% CI) cumulative opioid consumption (mg) at 12-hour postoperative was not found to be non-inferior in the lateral QLB (15.9 (12.7 to 19.2)) vs the LPB (12.7 (10.2 to 15.1)) group (p=0.625). Pain scores in postoperative anesthetic care unit (PACU) and 24-hour postoperative did not differ. The maximum distance ambulated did not differ, but lateral QLB patients were 2.4 times more likely to ambulate in the first 12 hours (p=0.024) and had significantly greater quadriceps strength in PACU (p<0.001).DiscussionAlthough we were unable to demonstrate non-inferiority for opioid consumption at 12-hour postoperative, strength and mobilization were improved in lateral QLB subjects.Trial registration numberNCT04402437.

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Section: Discussionmentioning

confidence: 99%

Comparison of lateral quadratus lumborum and lumbar plexus blocks for postoperative analgesia following total hip arthroplasty: a randomized clinical trial

Kelly

Wolla

Hay

et al. 2022

Reg Anesth Pain Med

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“…In our study, higher volume regimes increased the range of our blocks and reached a higher thoracic dermatomal distribution. Clinically, we chose different injection levels (L1–2, L3, L4) of QLB for different kinds of surgery (e.g., nephrectomy [ 17 ], cesarean delivery [ 18 ], hip arthroplasty [ 19 ]) to ease the spread of local anesthetic for fulfilling the requirement of local analgesia. Our study shows that different volumes can be used at one injection level at L2 to acquire a different block area for different clinical applications.…”

Section: Discussionmentioning

confidence: 99%

Anterior Quadratus Lumborum block area comparison in the three different volumes of Ropivacaine: a double-blind, randomized controlled trial in healthy volunteers

Shao

Luo

et al. 2022

BMC Anesthesiol

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Background In abdominal surgery, ultrasound-guided anterior quadratus lumborum blocks (QLB) are performed to induce analgesia. However, no study reported suitable volumes of the anterior QLB for the different postoperative analgesia regions. Therefore, this prospective randomized controlled study assessed the dermatomal spread and analgesic effects of the three different volumes of a local anesthetic for anterior QLB. Methods Ultrasound-guided anterior QLB was performed at the L2 level on 30 healthy volunteers. The volunteers were randomized to receive 20 ml (n = 10), 30 ml (n = 10), and 40 mL (n = 10) of 0.375% ropivacaine. The cutaneous sensory blocked area (CSBA), the number of block dermatomes, and the block duration time were measured by determining the extent of the cold sensation. Results The CSBA was significantly larger in the 40 ml group than in the 30 (P = 0.001; 1350.6 ± 234.4 vs. 1009.5 ± 151.6 cm2) and 20 ml groups (P < 0.001; 1350.6 ± 234.4 vs. 808.1 ± 120.5 cm2). Similarly, the number of blocked dermatomes was significantly higher in the 40 ml group than in the 30- and 20-ml groups. However, no significant difference was observed in block duration among the groups. Conclusions No difference was observed in block duration with the various volumes of 0.375% ropivacaine. However, the larger volume for anterior QLB contributed to a larger area of cutaneous sensory blockade. Appropriate volumes in anterior QLB can create suitable postoperative analgesia levels for the different operative sites. Trial registration The study was registered in the Chinese Clinical Trial Registration Center on www.chictr.org.cn on 27th April 2018 (registration number: ChiCTR-IOR-17010853).

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“…In our study, higher volume regimes increased the range of our blocks and reached a higher thoracic dermatomal distribution. Clinically, we chose different injection levels (L1-2, L3, L4) of QLB for different kinds of surgery (e.g., nephrectomy 17 , cesarean delivery 18 , hip arthroplasty 19 ) to ease the spread of local anesthetic for ful lling the requirement of local analgesia. Our study shows that at one injection level at L2, different volumes can be used to acquire a different block area for different clinical applications.…”

Section: Discussionmentioning

confidence: 99%

Anterior Quadratus Lumborum Block Area Comparison in the Three Different Volumes of Ropivacaine: A Double-blind, Randomized Controlled Trial in Healthy Volunteers

Shao

Luo

et al. 2022

Preprint

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Background In abdominal surgery, ultrasound-guided anterior quadratus lumborum blocks (QLB) are performed for inducing analgesia. However, no study reported the suitable volumes of the anterior QLB for the different postoperative analgesia regions. This prospective randomized controlled study assessed the dermatomal spread and analgesic effects of the three different volumes of a local anesthetic for anterior QLB. Methods Ultrasound-guided anterior QLB was performed at the L2 level on 30 healthy volunteers. The participants were randomized to receive 20 ml (n = 10), 30 ml (n = 10) and 40 mL (n = 10) of 0.375% ropivacaine. The cutaneous sensory blocked area (CSBA), the number of block dermatomes, and the block duration time were measured by determining the extent of the cold sensation. Results The CSBA was significantly larger in the 40 ml group than the 30 (P = 0.001; 1350.6 ± 234.4 vs 1009.5 ± 151.6 cm2) and 20 ml groups (P < 0.001; 1350.6 ± 234.4 vs 808.1 ± 120.5 cm2). Similarly, the number of blocked dermatomes was significantly higher in the 40 ml group than in the 30 and 20 ml groups. No significant difference was observed in block duration among the groups. Conclusions No difference was observed in block duration with the various volumes of 0.375% ropivacaine. However, the larger volume for anterior QLB contributed to a larger area of cutaneous sensory blockade. Appropriate volumes in anterior QLB can create suitable postoperative analgesia levels for the different operative sites. Trials Registration: The study was registered in the Chinese Clinical Trial Registration Center on www.chictr.org.cn on 27 April 2018 (registration number: ChiCTR-IOR-17010853).

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Comparison Between Ultrasound-Guided Suprainguinal Fascia Iliaca Block and Anterior Quadratus Lumborum Block for Total Hip Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Trial

Cited by 21 publications

References 34 publications

Comparison of lateral quadratus lumborum and lumbar plexus blocks for postoperative analgesia following total hip arthroplasty: a randomized clinical trial

Comparison of lateral quadratus lumborum and lumbar plexus blocks for postoperative analgesia following total hip arthroplasty: a randomized clinical trial

Anterior Quadratus Lumborum block area comparison in the three different volumes of Ropivacaine: a double-blind, randomized controlled trial in healthy volunteers

Anterior Quadratus Lumborum Block Area Comparison in the Three Different Volumes of Ropivacaine: A Double-blind, Randomized Controlled Trial in Healthy Volunteers

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