Postoperative pain treatment with transmuscular quadratus lumborum block and fascia iliaca compartment block in patients undergoing total hip arthroplasty: a randomized controlled trial

Abstract

Background Patients often suffer moderate or even severe pain after total hip arthroplasty; such pain seriously affects early postoperative recovery. This study aimed to investigate the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block combined with fascia iliaca compartment block for elderly patients undergoing total hip arthroplasty. Methods Fifty-four patients scheduled for total hip arthroplasty were included in this randomized controlled study. The patients were randomly assigned to receive only transmuscular quadratus lumborum block (group Q) or transmuscular quadratus lumborum block combined with fascia iliaca compartment block (group QF) with ultrasound guidance. Postoperatively in both groups, paracetamol 1 g was regularly administered at 6 h intervals and patient-controlled intravenous analgesia was administered. The primary outcome was cumulative sufentanil consumption via patient-controlled intravenous analgesia 24 h postoperatively. The secondary outcomes included pain degree, time to the first analgesic requirement, joint range of motion, quality of recovery, and the incidence of postoperative complications. Results Fifty patients were included, and their data were analyzed. The cumulative sufentanil consumption in group QF was significantly lower during the first 24 h after surgery than that in group Q, and the cumulative sufentanil consumption in group QF was reduced at 6–12 and 12–18 h after surgery. The postoperative pain intensity was lower in group QF than in group Q (linear mixed-effects model, the main effect of treatment: P < 0.001). Compared with group Q, group QF had higher quality of recovery and joint range of movement. The time to the first analgesic requirement was longer in group QF than in group Q (log-rank, P < 0.001). There was no statistically significant difference in complications postoperatively between the two groups. Conclusions Our study provides a multimodal, opioid-sparing analgesic regimen for elderly patients undergoing total hip arthroplasty. The combination of transmuscular quadratus lumborum block and fascia iliaca compartment block provides a significant advantage for early postoperative functional recovery. Further studies are required to confirm the minimum effective dose. Trial registration The study was registered on the 21st December 2020 (retrospectively registered) on the Chinese Clinical Trial Registry: ChiCTR2000038686.

Evaluation of Pericapsular Nerve Group (PENG) Block for Analgesic Effect in Elderly Patients with Femoral Neck Fracture Undergoing Hip Arthroplasty

“…Another investigator, namely, independent of group assignment, was responsible for collecting postoperative data. In the end, a statistician carried out the statistical analysis and kept the entire process confidential [ 12 ].…”

Logistic Regression Analysis of Risk Factors and Improvement of Clinical Treatment of Traumatic Arthritis after Total Hip Arthroplasty (THA) in the Treatment of Acetabular Fractures

“…Through the analysis of 569 patients with acetabular fractures, some scholars reported that the overall incidence of postoperative traumatic arthritis was 17%, of which the incidence of complete reduction was 10% and that of incomplete reduction was 35% [ 6 ]. Many literatures have pointed out that the postoperative effect is not satisfactory, which is often accompanied by joint dislocation, marginal compression, and ipsilateral femoral head fracture such as in the initial operation, which failed to fix the fracture, the necessary bone graft treatment, and often bring about serious complications [ 7 ]. Based on this, this study analyzed the risk factors of traumatic arthritis after THA in the treatment of acetabular fractures by logistic regression and promoted the clinical treatment methods to provide theoretical basis for clinical treatment.…”

Ultrasound-guided posterior quadratus lumborum block can reduce postoperative opioid consumption and promote rapid recovery in patients undergoing sutureless laparoscopic partial nephrectomy: A triple-blind, randomized, controlled study

“…Xia et al. ( 19 ) showed that using a single anterior QLB in knee arthroplasty significantly reduced postoperative opioid consumption and improved postoperative recovery scores. This discrepancy in results is most likely due to different approaches of QLB and local anesthetic doses.…”

“…Kwak et al (10) pointed out that using a single lateral QLB in laparoscopic partial nephrectomy can reduce postoperative opioid consumption, but the quality of recovery score at 48 h after surgery was not significantly different from that of the control group. Xia et al (19) showed that using a single anterior QLB in knee arthroplasty significantly reduced postoperative opioid consumption and improved postoperative recovery scores. This discrepancy in results is most likely due to different approaches of QLB and local anesthetic doses.…”