Comparison of Ultrasound-Guided Lumbar Erector Spinae Plane Block and Transmuscular Quadratus Lumborum Block for Postoperative Analgesia in Hip and Proximal Femur Surgery: A Prospective Randomized Feasibility Study

Serkan Tulgar, Halil Cihan Kose, Onur Selvi, Ozgur Senturk, David Terence Thomas, Mehmet Nurullah Ermis, Zeliha Ozer, Serkan Tulgar, Halil Cihan Kose, Onur Selvi, Ozgur Senturk, David Terence Thomas, Mehmet Nurullah Ermis, Zeliha Ozer

Abstract

Study objective: Lumbar Erector spinae Plane block (L-ESPB) is a modification of a recently described block. Both L-ESPB and Transmuscular Quadratus Lumborum block (QLB-T) have been reported to provide effective postoperative analgesia in hip and proximal femur surgery. Herein, we compare the effectiveness of L-ESPB and QLB-T in providing postoperative analgesia in patients undergoing hip and femur operations.

Design: Double-blinded, prospective, randomized, feasibility study.

Setting: Tertiary university hospital, postoperative recovery room and ward.

Methodology: A total of 72 patients (American Society of Anesthesiology physical status classification II-III) were recruited. After exclusion, 60 patients were allocated to three equal groups (control, L-ESB and QLB-t).

Interventions: Standard multimodal analgesia was performed in the control group while L-ESPB or QLB-T was performed in the block groups.

Measurements: Pain intensity between groups was compared using Numeric Rating Scores. Furthermore, tramadol consumption and additional rescue analgesic requirement was measured.

Results: There was no difference between demographic data or type of surgery. While there was no difference in Numeric Rating Scale (NRS) score at any hour between the block groups; NRS scores at the 1st, 3rd and 6th h, tramadol consumption during the first 12 h and total tramadol consumption, the number of patient required rescue analgesic in 24 h were significantly higher in the control group compared to both block groups.

Conclusion: While L-ESPB and QLB-T have similar effect, they improve analgesia quality in patients undergoing hip and proximal femoral surgery when compared to standard intravenous analgesia regimen.

Keywords: Erector spinae plane block; hip surgery; quadratus lumborum block.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
CONSORT diagram of study
Figure 2
Figure 2
(a-c) Performing of QLB-t, (d-f) Performing of L-ESPB, QLM: Quadratus Lumborum muscle, PM: Psoas muscle, ESM: Erector spinae muscles, L4: Transvers process of 4th lumbar vertebra, L5: Transvers process of 5th lumbar vertebra, Sc: Sacrum, Yellow arrow: injection point, Black arrows: Spread are of local anesthetics

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