Preoperative L1 and L2 paravertebral block is an effective postoperative analgesia for hip arthroscopy in a multimodal analgesic regimen

Ilkhchoui, Yashar; Arndt, Christopher; Koshkin, Eugene; Vagh, Firoz

doi:10.1136/bcr-2013-010496

Cited by 11 publications

(8 citation statements)

References 15 publications

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“…The anteromedial innervation is mainly provided by the obturator nerve and branches thereof, the anterior hip is innervated by the femoral nerve, the posterior is mainly innervated by the sciatic nerve and branches, while the posteromedial aspect of the hip joint also receives branches from the nerve to the quadratus femoris [ 30 ]. Although paravertebral blocks of L1–L2 have been noted to have positive outcomes in the context of hip arthroscopy [ 31 , 32 ], QL blocks have the theoretical advantage of more thoroughly covering the complex innervation of the hip.…”

Section: Discussionmentioning

confidence: 99%

Quadratus lumborum block provides improved immediate postoperative analgesia and decreased opioid use compared with a multimodal pain regimen following hip arthroscopy

McCrum

Ben‐David

Shin

et al. 2018

Journal of Hip Preservation Surgery

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The purpose of our study was to evaluate the effect on immediate patient outcomes following hip arthroscopy with use of a preoperative, single shot quadratus lumborum (QL) block. We retrospectively reviewed patients who underwent hip arthroscopy following a preoperative QL block. These patients were matched by age and gender to patients who had not received a block. Visual analogue scale (VAS) pain scores immediately postoperatively and at the time of discharge were recorded. Hourly and overall opioid intake in the postanesthesia care unit (PACU) was also recorded. Continuous data was analysed with paired t-test, with significance being defined as P < 0.05. Complications in the immediate postoperative period were recorded, as was time from admission to PACU to discharge. Fifty-six patients were included. Twenty-eight patients underwent QL block and 28 did not undergo a block. QL block patients required significantly less hydromorphone (P = 0.010) and oxycodone (P = 0.001) during their time in the PACU, and significantly fewer morphine equivalents overall and per hour in the PACU (P < 0.001). Despite receiving less opioid analgesia, QL block patients had significantly less pain immediately postoperatively (P = 0.026) and at the time of discharge (P = 0.015). The mean time to PACU discharge was 155 ± 49 min, and there was no difference in time to discharge between groups (P = 0.295). One patient in the QL block group experienced persistent flank numbness. Hip arthroscopy patients who received a preoperative QL block had less pain and a lower opioid requirement in PACU than those who did not receive a block. Level of Evidence: Level III (Retrospective matched cohort study).

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Section: Discussionmentioning

confidence: 99%

Quadratus lumborum block provides improved immediate postoperative analgesia and decreased opioid use compared with a multimodal pain regimen following hip arthroscopy

McCrum

Ben‐David

Shin

et al. 2018

Journal of Hip Preservation Surgery

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“…A case-report suggests that L1-L2 paravertebral blocks might have a similar effect on postoperative VAS pain scores for hip arthroscopy patients [7, 35]. Overall, a paravertebral block might provide the patient with better options for early mobilization and possibly early same day hospital discharge although so far there are no clinical trials performed which support this.…”

Section: Discussionmentioning

confidence: 99%

Perioperative pain management in hip arthroscopy; what options are there?

et al. 2016

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Hip arthroscopy is a fast growing orthopedic field of expertise. As in any field of surgery adequate postoperative pain management regimes are of utmost importance. The purpose of this review is to provide an overview of current knowledge on anesthetic options for perioperative pain management for hip arthroscopy. We searched the Pubmed/Medline and Embase database for literature and included 10 studies for our analysis. Because of the variety of pain scales and different ways of measured pain no meta-analysis could be performed and a descriptive review is performed. There are several types of pain regimens that can mostly be divided in two groups: local anesthetics and nerve blocks. Included studies show a rather large variation in reported visual analogue scale scores, post anesthesia care unit admission time and opioid usage. There are several anesthetic options available for hip arthroscopy. Different studies use different dosages, anesthetic regimens and different protocols; this partly explains the differences between studies with similar techniques. Peripheral nerve blocks seems promising but regarding current literature no clear recommendation can be made about what the best perioperative pain management option is, an overview of all reported techniques is given.

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“…On the contrary, a recent case report again reports good efficacy of the block in a single patient along with motor preservation [20].…”

Section: Lumbar Paravertebral Blocks For Hip Surgerymentioning

confidence: 95%

Update on paravertebral blocks

Wardhan¹

2015

Current Opinion in Anaesthesiology

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Preoperative L1 and L2 paravertebral block is an effective postoperative analgesia for hip arthroscopy in a multimodal analgesic regimen

Cited by 11 publications

References 15 publications

Quadratus lumborum block provides improved immediate postoperative analgesia and decreased opioid use compared with a multimodal pain regimen following hip arthroscopy

Quadratus lumborum block provides improved immediate postoperative analgesia and decreased opioid use compared with a multimodal pain regimen following hip arthroscopy

Perioperative pain management in hip arthroscopy; what options are there?

Update on paravertebral blocks

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