A Retrospective Study on the Comparison between Lumbar Plexus Block and Quadratus Lumborum Block on the Postoperative Pain in Total Hip Replacement Patients
Utchariya Anantamongkol and Anna
Correspondence Address :
Department of Anesthesiology
Marshfield Clinic Marshfield
Received on: November 22, 2019, Accepted on: December 07, 2019, Published on: December 27, 2019
Citation: Utchariya Anantamongkol and Anna Uskova (2019). A retrospective study on the comparison between lumbar plexus block and quadratus
lumborum block on the postoperative pain in total hip replacement patients
Copyright: 2019 Utchariya Anantamongkol, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Introduction: Lumbar plexus block (LPB) is known to provide effective postoperative analgesia for hip surgeries. However, there were concerns of quadriceps weakness from the motor blockade that may affect early ambulation. Several recent studies showed the effectiveness of quadratus lumborum block (QLB) for postoperative analgesia after hip surgeries. We proposed that QLB type 1 was as effective as LPB for postoperative analgesia in total hip replacement patient and facilitate early ambulation and participation in physical therapy.
Materials and methods: Retrospective data were collected from 120 consecutive patients who underwent primary, unilateral total hip replacement by the same surgeon. They were assigned to either pre-operative ultrasound guided QLB type 1 or traditional LPB performed with nerve stimulator. Postoperative outcomes were assessed by opioid consumption (oral morphine equivalents), visual analog scale (VAS) score, time required to perform nerve blocks, time to achieve physical therapy goals, complications and length of hospital stay.
Results/Case report: After exclusion, we had 54 patients in each group (QLB vs LPB). We found similar outcomes in VAS scores at 0 h (2.69 +/- 3.04 vs 3.56 +/- 3.10), 12 h (4.44 +/- 2.40 vs 4.56 +/- 2.55) and 24 h (2.33 +/- 2.50 vs 2.80 +/- 2.29) after the surgery, total opioid consumption at 12 h (42.63 +/- 25.04 mg vs 43.19 +/- 23.29 mg) and 24 h (16.38 +/- 19.09 mg vs 19.09 +/- 16.46 mg) after surgery (all p-value > 0.05). Time to achieve physical therapy goals (22.24 +/- 15.75 h vs 24.81 +/- 15.57 h) and length of hospital stay (28.86 +/- 15.67 h vs 34.04 +/- 17.37 h) were comparable between QLB and LPB groups, p-value > 0.05. There were no complications reported from neither technique. Interestingly, significantly less timewas required to perform QLB when compared to LPB (7.16 +/- 3.32 min vs 14.2 +/- 9.84 min,p-value < 0.01).
Discussion: Our study suggests non-inferior effectiveness of QLB type 1 in postoperative analgesia and preservation of motor function when compared to traditional LPB in the first 24 h following total hip arthroplasty. As it is easier to perform QLB (with ultrasound guidance only and no need for the use of nerve stimulator), QLB consumed less time to complete the procedure.
Keywords: Quadratus lumborum block, Lumbar plexus block, Postoperative hip pain, Total hip Arthroplasty.