Transmuscular quadratus lumborum versus lumbar plexus block for total hip arthroplasty: A retrospective propensity score matched cohort study

Sanjib D Adhikary, Anthony J Short, Kariem El-Boghdadly, Mena J Abdelmalak, Ki Jinn Chin, Sanjib D Adhikary, Anthony J Short, Kariem El-Boghdadly, Mena J Abdelmalak, Ki Jinn Chin

Abstract

Background and aims: Cadaveric studies have shown that injectate from transmuscular quadratus lumborum block (QLB) can spread to the lumbar plexus. Our aim was to compare analgesic efficacy of transmuscular QLB with lumbar plexus block (LPB) for patients undergoing total hip arthroplasty (THA).

Material and methods: Thirty patients receiving transmuscular QLB were propensity score matched with 30 patients receiving LPB for age, sex, ASA score, BMI, operative time, preoperative oxycodone, and intraoperative opioid use. The primary outcome was postoperative opioid consumption during the first 24 postoperative hours. Secondary outcomes included static pain scores at 0-12, 12-24, and 24-48 h intervals, opioid consumption at 0-12, 12-24, and 24-48 h intervals and the length of hospital stay. The incidence of severe adverse events was also compared.

Results: Opioid consumption (median [IQR]) in the first 24 h was similar between the transmuscular QLB and LPB patient groups-33.6 mg (22.9-48.5) versus 32.8 mg (24.8-58.3) intravenous morphine equivalents. There was no difference between groups in static pain scores or opioid consumption during any time interval up to 48 h postoperatively. Length of hospital stay (median [IQR]) was similar between the transmuscular QLB and LPB groups-55.6 h (53.7-60.3) versus 57.9 h (54.3-79.1).

Conclusions: This study suggests that transmuscular QLB provides similar analgesia to LPB following THA. Prospective studies are needed to confirm this.

Keywords: Analgesia; nerve block; postoperative pain; total hip replacement; ultrasound.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Ultrasound image of anterior quadratus lumborum block injection. The asterisk indicates point of injection, between quadratus lumborum (QLM) and psoas major (PMM) muscles. The posterior-to-anterior needle trajectory is indicated by the dotted line. EOM—external oblique muscle, ESM—erector spinae muscle, IOM—internal oblique muscle, LDM—latissimus dorsi muscle, PMM—psoas major muscle, QLM—quadratus lumborum muscle, SP—spinous process, TAM—transversus abdominis muscle, TP—transverse process, VB—vertebral body. Image used with permission of KJ Chin Medicine Professional Corporation

References

    1. Morrison RS, Magaziner J, McLaughlin MA, Orosz G, Silberzweig SB, Koval KJ, et al. The impact of post-operative pain on outcomes following hip fracture. Pain. 2003;103:303–11.
    1. Karlsen AP, Geisler A, Petersen PL, Mathiesen O, Dahl JB. Postoperative pain treatment after total hip arthroplasty: Asystematic review. Pain. 2015;156:8–30.
    1. Fischer HB, Simanski CJ, Sharp C, Bonnet F, Camu F, Neugebauer EA, et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia. 2008;63:1105–23.
    1. Touray ST, de Leeuw MA, Zuurmond WW, Perez RS. Psoas compartment block for lower extremity surgery: A meta-analysis. Br J Anaesth. 2008;101:750–60.
    1. Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mercier FJ, et al. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002;97:1274–80.
    1. Carline L, McLeod GA, Lamb C. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks. Br J Anaesth. 2016;117:387–94.
    1. Adhikary SD, El-Boghdadly K, Nasralah Z, Sarwani N, Nixon AM, Chin KJ. A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers. Anaesthesia. 2017;72:73–9.
    1. Parras T, Blanco R. Randomised trial comparing the transversus abdominis plane block posterior approach or quadratus lumborum block type I with femoral block for postoperative analgesia in femoral neck fracture, both ultrasound-guided. Rev Esp Anestesiol Reanim. 2016;63:141–8.
    1. Ueshima H, Yoshiyama S, Otake H. The ultrasound-guided continuous transmuscular quadratus lumborum block is an effective analgesia for total hip arthroplasty. J Clin Anesth. 2016;31:35.
    1. Hockett MM, Hembrador S, Lee A. Continuous quadratus lumborum block for postoperative pain in total hip arthroplasty: A case report. A A Case Rep. 2016;7:129–31.
    1. Capdevila X, Macaire P, Dadure C, Choquet O, Biboulet P, Ryckwaert Y, et al. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: New landmarks, technical guidelines, and clinical evaluation. Anesth Analg. 2002;94:1606–13.
    1. Borglum J, Moriggl B, Jensen K, Lønnqvist PA, Christensen AF, Sauter A, et al. Ultrasound-guided transmuscular quadratus lumborum blockade. Br J Anaesth. 2013;111
    1. El-Boghdadly K, Elsharkawy H, Short A, Chin KJ. Quadratus lumborum block nomenclature and anatomical considerations. Reg Anesth Pain Med. 2016;41:548–9.
    1. Thoemmes F. Propensity score matching in SPSS. arXiv Preprint arXiv: 12016385. [Last accessed on 2017 Jun 11]. Available from: .
    1. Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: A qualitative systematic review. Anesthesiology. 2009;111:657–77.
    1. Kane SP. Opioid (Opiate) Equianalgesia Conversion Calculator. [Last accessed on 2017 Mar 06]. Available from: .
    1. Thoemmes FJ, Kim ES. A systematic review of propensity score methods in the social sciences. Multivariate Behav Res. 2011;46:90–118.
    1. Newcombe RG. Confidence intervals for an effect size measure based on the Mann–Whitney statistic. Part 1: General issues and tail-area-based methods. Stat Med. 2006;25:543–57.
    1. Newcombe RG. Confidence intervals for an effect size measure based on the Mann–Whitney statistic. Part 2: Asymptotic methods and evaluation. Stat Med. 2006;25:559–73.
    1. O’Brien R. WMWodds.Rfunc170102.R. The Rfuncs Project - R Functions to Promote Contemporary Statistical Science. [Last accessed on 2017 May 29]. Available from: .
    1. Holm S. A simple sequentially rejective multiple test procedure. Scand J Statist. 1979;6:65–70.
    1. Ludbrook J. Multiple inferences using confidence intervals. Clin Exp Pharmacol Physiol. 2000;27:212–5.
    1. Divine G, Norton HJ, Hunt R, Dienemann J. Statistical grand rounds: A review of analysis and sample size calculation considerations for Wilcoxon tests. Anesth Analg. 2013;117:699–710.
    1. Blanco R. TAP block under ultrasound guidance: The description of a “no pops” technique. Reg Anesth Pain Med. 2007;32:S130.
    1. Blanco R, McDonnell JG. Optimal point of injection: The quadratus lumborum type I and II blocks. Anaesthesia. [Last accessed on 2017 Nov 14]. Available from: .
    1. Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol. 2013;29:550–2.
    1. Kadam VR. Ultrasound guided quadratus lumborum block or posterior transversus abdominis plane block catheter infusion as a postoperative analgesic technique for abdominal surgery. J Anaesthesiol Clin Pharmacol. 2015;31:130–1.
    1. Baidya DK, Maitra S, Arora MK, Agarwal A. Quadratus lumborum block: An effective method of perioperative analgesia in children undergoing pyeloplasty. J Clin Anesth. 2015;27:694–6.
    1. Chakraborty A, Goswami J, Patro V. Ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient. A A Case Rep. 2015;4:34–6.
    1. Visoiu M, Yakovleva N. Continuous postoperative analgesia via quadratus lumborum block-an alternative to transversus abdominis plane block. Paediatr Anaesth. 2013;23:959–61.
    1. Shaaban M, Esa WA, Maheshwari K, Elsharkawy H, Soliman LM. Bilateral continuous quadratus lumborum block for acute postoperative abdominal pain as a rescue after opioid-induced respiratory depression. A A Case Rep. 2015;5:107–11.
    1. Murouchi T, Iwasaki S, Yamakage M. Quadratus lumborum block: Analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery. Reg Anesth Pain Med. 2016;41:146–50.
    1. Dam M, Moriggl B, Hansen CK, Hoermann R, Bendtsen TF, Børglum J. The pathway of injectate spread with the transmuscular quadratus lumborum block: A cadaver study. Anesth Analg. 2017;125:303–12.
    1. Ueshima H, Otake H. Lower limb amputations performed with anterior quadratus lumborum block and sciatic nerve block. J Clin Anesth. 2017;37:145.
    1. Wikner M. Unexpected motor weakness following quadratus lumborum block for gynaecological laparoscopy. Anaesthesia. 2017;72:230–2.
    1. Ueshima H, Hiroshi O. Incidence of lower-extremity muscle weakness after quadratus lumborum block. J Clin Anesth. 2018;44:104.
    1. Kumar A, Sadeghi N, Wahal C, Gadsden J, Grant SA. Quadratus Lumborum Spares Paravertebral Space in Fresh Cadaver Injection. Anesth Analg. 2017;125:708–9.
    1. Tamura T, Kitamura K, Yokota S, Ito S, Shibata Y, Nishiwaki K. Spread of Quadratus Lumborum Block to the Paravertebral Space Via Intramuscular Injection: A Volunteer Study. Reg Anesth Pain Med. 2018 [Epub ahead of print]
    1. Biboulet P, Morau D, Aubas P, Bringuier-Branchereau S, Capdevila X. Postoperative analgesia after total-hip arthroplasty: Comparison of intravenous patient-controlled analgesia with morphine and single injection of femoral nerve or psoas compartment block. A prospective, randomized, double-blind study. Reg Anesth Pain Med. 2004;29:102–9.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel