The effects of transmuscular quadratus lumborum blocks on postoperative pain in arthroscopic hip surgery: a cohort analysis

Kinjo, Sakura; Kolodzie, Kerstin; Dong, Katherine; Zhang, Alan L.

doi:10.1007/s00540-019-02659-9

Cited by 17 publications

(17 citation statements)

References 25 publications

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“…6 The QLB encompasses four distinct blocks according to the position of the needle tip in relation to the quadratus lumborum muscle: lateral, posterior, anterior (transmuscular), or intramuscular. 7,8 Cadaveric studies of the transmuscular QLB showed direct dye spread to the roots and branches of the lumbar plexus; 9,10 thus, these studies supported the possible benefit of QLB in hip surgery. Few clinical reports have evaluated the use of transmuscular QLB in hip arthroplasty.…”

Section: Introductionmentioning

confidence: 78%

Transmuscular Quadratus Lumborum Block versus Suprainguinal Fascia Iliaca Block for Hip Arthroplasty: A Randomized, Controlled Pilot Study

Nassar¹,

Hasanin²,

Sewilam³

et al. 2021

LRA

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Background: This study aimed to investigate the analgesic efficacy and motor block profile of single-shot transmuscular quadratus lumborum block (QLB) in comparison with those of suprainguinal fascia iliaca block (FIB) in patients undergoing hip arthroplasty. Methods: This randomized, double-blinded, controlled trial included adult patients undergoing hip arthroplasty under spinal anesthesia. Patients were allocated to one of two groups according to the regional block received: FIB group (n=19) or QLB group (n=17). Both study groups were compared with regard to the duration of analgesia (primary outcome), block performance time, pain during positioning for spinal anesthesia, total morphine consumption in the first postoperative 24-h period, quadriceps muscle power, and static and dynamic visual analog scale. Results: Thirty-six patients were included in the final analysis. Both study groups had comparable durations of analgesia. Postoperative visual analog scale (static and dynamic) values were comparable between the two groups in most readings. The block performance time was shorter in the FIB group. The number of patients with pain during positioning for the subarachnoid block was lower in the QLB group. The total morphine requirement during the first 24 h was marginally lower in the FIB group, whereas the quadriceps motor grade was higher in the FIB group than in the QLB group at 4 h and 6 h after surgery. Conclusion: Both single-shot blocks, namely the suprainguinal FIB and transmuscular QLB, provide effective postoperative analgesia after hip arthroplasty. FIB showed slightly lower 24-h morphine consumption, while QLB showed better quadriceps motor power. Clinical Trial Registration: The study was registered at clinical trials registry system before enrollment of the first participant (NCT04005326; initial release date, 2 July 2019; https://clinicaltrials.gov/ct2/show/NCT04005326).

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Section: Introductionmentioning

confidence: 78%

Transmuscular Quadratus Lumborum Block versus Suprainguinal Fascia Iliaca Block for Hip Arthroplasty: A Randomized, Controlled Pilot Study

Nassar¹,

Hasanin²,

Sewilam³

et al. 2021

LRA

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“…Similar findings have been seen with QL blocks for hip arthroscopy, which were shown to be superior to a multimodal pain regimen alone; however, procedures in this study were relatively short with very few labral repairs and femoroplasties performed, which may not be representative of the most common hip arthroscopy procedures performed. 13 In contrast, a recent study of 15 patients receiving a QL block versus 54 patients in the control group by Kinjo et al 16 reported that, when compared with no regional block, QL blocks were not an effective analgesic technique for hip arthroscopy for femoroacetabular impingement. They acknowledge their relatively small sample size in the experimental group as a limitation and speculate that subtle differences in block location could lead to variable anesthetic spread.…”

Section: Discussionmentioning

confidence: 96%

“…In the current literature, one study has shown QL blocks to be superior to a multimodal pain regimen alone for improving perioperative pain and reducing opioid consumption; however, a second cohort study found QL blocks to not be an effective analgesic technique in hip arthroscopy. 13,16 No studies to date have directly compared the effectiveness of QL blocks versus the more common femoral nerve or fascia iliaca (F/FI) blocks in hip arthroscopy. The purpose of this study is to evaluate the effect of the single-shot QL block versus F/FI blocks performed preoperatively on perioperative opioid requirements, subjective pain scores, and time to discharge.…”

mentioning

confidence: 99%

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

Blackwell

Kushelev

Norton

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To evaluate the effect of the single-shot quadratus lumborum (QL) block versus femoral nerve and fascia iliacus (F/FI) blocks performed preoperatively on perioperative opioid requirements, subjective pain scores, and time to discharge. Methods Patients who underwent hip arthroscopy for femoroacetabular impingement and had a preoperative nerve block between January 2017 and August 2019 at our institution were identified. Patients were separated into 2 groups: those who either received a preoperative single-shot QL block or a preoperative single-shot F/FI block. All patients received general anesthesia. Intraoperative, postanesthesia care unit (PACU), and total morphine equivalents were analyzed using unpaired t test. Secondary outcome measures including total time in PACU and block-related complications were recorded and analyzed as well. Results One hundred one patients were retrospectively reviewed. Forty-three patients received preoperative QL blocks, and 58 patients received preoperative F/FI blocks. Demographics and operative characteristics were similar between the 2 groups. Patients receiving a QL block required significantly lower total morphine equivalents (63.1 vs 87.0, P < .001). Patients receiving a QL block also had shorter PACU stays (116 vs 148 minutes, P < .001) and lower subjective pain scores at the time of discharge (3.27 vs 4.98, P < .001) compared with the F/FI block group. There were also significant decreases in the number of intraoperative opioids (42.1 vs 58.4, P < .001) and PACU opioids (20.7 vs 28.7, P = .03) used when analyzed separately. Two patients in the femoral nerve block group had noted a fall postoperatively while the block was in effect. No patients in the QL block group had a block-related complication. Conclusions Patients receiving a preoperative QL block for hip arthroscopy demonstrated lower total opioid requirements, shorter PACU stay, and lower pain scores at discharge than patients receiving preoperative F/FI blocks with no reported adverse events. Level of Evidence Level III, retrospective comparative trial.

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“…Ultrasound-guided QLB technique was first described by Blanco [11,12], and the benefits of QLB for postoperative pain relief and opioids-sparing effect have been reported by several randomized controlled trials and case reports [2,5,6,[8][9][10][19][20][21][22][23][24][25][26][27][28][29][30]. All approaches have been proved the synergistic efficacy for multimode analgesia, especially for QLB2 or QLB3 after laparoscopic surgery, cesarean section and total hip arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided Quadratus Lumborum Block for Perioperative Analgesia in Robot-assisted Partial Nephrectomy: A Randomized Controlled Trial

Lai

Luo

Liu

et al. 2020

Preprint

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Background Recently, several case reports and limited randomized studies have shown that the quadratus lumborum block (QLB) is effective in providing pain relief after intra-abdominal and retroperitoneal operations. Robot-assisted partial nephrectomy (RAPN) has also been proposed as a promising operative treatment for renal carcinoma because it enables early recovery and ambulation. Therefore, we aimed to evaluate the analgesic and opioid-sparing effects of a single-injection QLB, which may paly an important role on early recovery program in RAPN.MethodsFifty-six patients undergoing elective RAPN under general anesthesia were randomised to two equally sized groups. Patients were randomly allocated to receive unilateral QLB (n=28) with 0.375% bupivacaine 0.5 mL/kg (QLB group) or a conventional scheme (n=28) group (Control group). The QLB technique was performed as first described by Blanco, termed QLB2. The primary outcome was the visual analogue scale (VAS) scores with movement at 6 hours postoperatively. The secondary endpoints were the morphine consumption at different time-period after surgery, morphine-related side effects and assessment of postoperative rehabilitation. ResultsBoth VAS pain score and cumulative opioid consumption were significantly lower in the QLB group at 6 hours after surgery as compared with the control group (all P<0.05). There was significant difference in pain scores at any other time-point except at 4 hours on movement and 48 hours at rest. However, no significant difference was observed in 12-48 hours cumulative opioid consumption, and in the duration of PACU and hospital stay between the two groups. The patient recovery scores was significantly higher in the QLB group.ConclusionsSingle-injection pre-emptive QLB applied to RAPN was effective and provided satisfactory analgesia and opioids-sparing in combination with a typical patient-controlled analgesia. In addition, it may provide an effective technique for early recovery in perioperative period.

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The effects of transmuscular quadratus lumborum blocks on postoperative pain in arthroscopic hip surgery: a cohort analysis

Cited by 17 publications

References 25 publications

Transmuscular Quadratus Lumborum Block versus Suprainguinal Fascia Iliaca Block for Hip Arthroplasty: A Randomized, Controlled Pilot Study

Transmuscular Quadratus Lumborum Block versus Suprainguinal Fascia Iliaca Block for Hip Arthroplasty: A Randomized, Controlled Pilot Study

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

Ultrasound-guided Quadratus Lumborum Block for Perioperative Analgesia in Robot-assisted Partial Nephrectomy: A Randomized Controlled Trial

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