Skip to main content
Erschienen in: Journal of Anesthesia 4/2019

01.07.2019 | Original Article

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

verfasst von: Sakura Kinjo, Kerstin Kolodzie, Katherine Dong, Alan L. Zhang

Erschienen in: Journal of Anesthesia | Ausgabe 4/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The Transmuscular Quadratus Lumborum block (TQLB) is one of the newest blocks and has been used as an effective analgesic option for various surgeries. However, it is still uncertain whether the TQLB provides beneficial analgesic outcomes for hip arthroscopic surgeries. Therefore, we aimed to investigate effects of the preoperative TQLB on postoperative pain levels and perioperative opioid consumption in patients who underwent outpatient arthroscopic hip surgery.

Methods

In this retrospective cohort study, patients who underwent arthroscopic hip surgery for femoroacetabular impingement (FAI) between June 1, 2017 and December 1, 2017 were included. All patients received general anesthesia for surgery. Two groups of patients were compared: (1) patients who received a preoperative TQLB, (2) patients who did not receive a TQLB.

Results

Seventy procedures (68 patients) were included in the study. Of these, 15 procedures (15 patients) received a preoperative TQLB (TQLB group) in addition to general anesthesia, whereas the other 55 procedures (54 patients) received general anesthesia only (control group). Highest pain scores in the PACU were similar in the TQLB (6.2) group versus the control group (5.6) (95% CI \(-\) 2.08 to 0.99, p = 0.484). Pain scores decreased over time in both groups and there were no statistical differences in mean values or absolute risk differences between study groups (95% CI \(-\) 0.19 to 0.33, P = 0.596). In addition, there were no significant differences in perioperative opioid consumption, length of PACU stay, or the need for a rescue block in the PACU between the two groups.

Conclusion

The present study did not find the preoperative TQLB to be an effective analgesic technique for patients who underwent arthroscopic hip surgery for FAI. A randomized clinical trial may further validate these results.
Literatur
1.
Zurück zum Zitat YaDeau JT, Tedore T, Goytizolo EA, Kim DH, Green DS, Westrick A, Fan R, Rade MC, Ranawat AS, Coleman SH, Kelly BT. Lumbar plexus blockade reduces pain after hip arthroscopy: a prospective randomized controlled trial. Anesth Analg. 2012;115(4):968–72.CrossRefPubMed YaDeau JT, Tedore T, Goytizolo EA, Kim DH, Green DS, Westrick A, Fan R, Rade MC, Ranawat AS, Coleman SH, Kelly BT. Lumbar plexus blockade reduces pain after hip arthroscopy: a prospective randomized controlled trial. Anesth Analg. 2012;115(4):968–72.CrossRefPubMed
2.
Zurück zum Zitat Schroeder KM, Donnelly MJ, Anderson BM, Ford MP, Keene JS. The analgesic impact of preoperative lumbar plexus blocks for hip arthroscopy: a retrospective review. Hip Int. 2013;23(1):93–8.CrossRefPubMed Schroeder KM, Donnelly MJ, Anderson BM, Ford MP, Keene JS. The analgesic impact of preoperative lumbar plexus blocks for hip arthroscopy: a retrospective review. Hip Int. 2013;23(1):93–8.CrossRefPubMed
3.
Zurück zum Zitat Lee EM, Murphy KP, Ben-David B. Postoperative analgesia for hip arthroscopy: combined L1 and L2 paravertebral blocks. J Clin Anesth. 2008;20(6):462–5.CrossRefPubMed Lee EM, Murphy KP, Ben-David B. Postoperative analgesia for hip arthroscopy: combined L1 and L2 paravertebral blocks. J Clin Anesth. 2008;20(6):462–5.CrossRefPubMed
4.
Zurück zum Zitat Ward JP, Albert DB, Altman R, Goldstein RY, Cuff G, Youm T. Are femoral nerve blocks effective for early postoperative pain management after hip arthroscopy? Arthroscopy. 2012;28(8):1064–9.CrossRefPubMed Ward JP, Albert DB, Altman R, Goldstein RY, Cuff G, Youm T. Are femoral nerve blocks effective for early postoperative pain management after hip arthroscopy? Arthroscopy. 2012;28(8):1064–9.CrossRefPubMed
5.
Zurück zum Zitat Childs S, Pyne S, Nandra K, Bakhsh W, Mustafa SA, Giordano BD. The effect of intra-articular cocktail versus femoral nerve block for patients undergoing hip arthroscopy. Arthroscopy. 2017;33(12):2170–6.CrossRefPubMed Childs S, Pyne S, Nandra K, Bakhsh W, Mustafa SA, Giordano BD. The effect of intra-articular cocktail versus femoral nerve block for patients undergoing hip arthroscopy. Arthroscopy. 2017;33(12):2170–6.CrossRefPubMed
6.
Zurück zum Zitat Krych AJ, Baran S, Kuzma SA, Smith HM, Johnson RL, Levy BA. Utility of multimodal analgesia with fascia iliaca blockade for acute pain management following hip arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):843–7.CrossRefPubMed Krych AJ, Baran S, Kuzma SA, Smith HM, Johnson RL, Levy BA. Utility of multimodal analgesia with fascia iliaca blockade for acute pain management following hip arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):843–7.CrossRefPubMed
7.
Zurück zum Zitat Garner M, Alshameeri Z, Sardesai A, Khanduja V. A prospective randomized controlled trial comparing the efficacy of fascia iliaca compartment block versus local anesthetic infiltration after hip arthroscopic surgery. Arthroscopy. 2017;33(1):125–32.CrossRefPubMed Garner M, Alshameeri Z, Sardesai A, Khanduja V. A prospective randomized controlled trial comparing the efficacy of fascia iliaca compartment block versus local anesthetic infiltration after hip arthroscopic surgery. Arthroscopy. 2017;33(1):125–32.CrossRefPubMed
8.
Zurück zum Zitat Behrends M, Yap EN, Zhang AL, Kolodzie K, Kinjo S, Harbell MW, Aleshi P. Preoperative fascia iliaca block does not improve analgesia after arthroscopic hip surgery, but causes quadriceps muscles weakness: a randomized double-blind trial. Anesthesiology. 2018;129(3):536–43.CrossRefPubMed Behrends M, Yap EN, Zhang AL, Kolodzie K, Kinjo S, Harbell MW, Aleshi P. Preoperative fascia iliaca block does not improve analgesia after arthroscopic hip surgery, but causes quadriceps muscles weakness: a randomized double-blind trial. Anesthesiology. 2018;129(3):536–43.CrossRefPubMed
9.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
10.
Zurück zum Zitat Yayik AM, Cesur S, Ozturk F, Ahiskalioglu A, Celik EC. Continuous quadratus lumborum type 3 block provides effective postoperative analgesia for hip surgery. Rev Bras Anestesiol. 2019;69(2):208–10.CrossRefPubMed Yayik AM, Cesur S, Ozturk F, Ahiskalioglu A, Celik EC. Continuous quadratus lumborum type 3 block provides effective postoperative analgesia for hip surgery. Rev Bras Anestesiol. 2019;69(2):208–10.CrossRefPubMed
11.
Zurück zum Zitat Ahiskalioglu A, Yayik AM, Alici HA, Ezirmik N. Ultrasound guided transmuscular quadratus lumborum block for congenital hip dislocation surgery: report of two pediatric cases. J Clin Anesth. 2018;49:15–6.CrossRefPubMed Ahiskalioglu A, Yayik AM, Alici HA, Ezirmik N. Ultrasound guided transmuscular quadratus lumborum block for congenital hip dislocation surgery: report of two pediatric cases. J Clin Anesth. 2018;49:15–6.CrossRefPubMed
12.
Zurück zum Zitat Børglum J, Moriggl B, Jensen K, Lønnqvist PA, Christensen AF, Sauter A, Bendtsen TF. Ultrasound-guided transmuscular quadratus lumborum blockade. Br J Anaesth. 2013;111(eletter supplement):2. doi: 10.1093/bja/el9919. Børglum J, Moriggl B, Jensen K, Lønnqvist PA, Christensen AF, Sauter A, Bendtsen TF. Ultrasound-guided transmuscular quadratus lumborum blockade. Br J Anaesth. 2013;111(eletter supplement):2. doi: 10.1093/bja/el9919.
13.
Zurück zum Zitat Kadam VR, Howell S. Ultrasound-guided continuous transmuscular quadratus lumborum block- L4 or L2 level catheter insertion for analgesia in open abdominal surgery: case series. Indian J Anaesth. 2018;62(7):555–7.CrossRefPubMedPubMedCentral Kadam VR, Howell S. Ultrasound-guided continuous transmuscular quadratus lumborum block- L4 or L2 level catheter insertion for analgesia in open abdominal surgery: case series. Indian J Anaesth. 2018;62(7):555–7.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Warusawitharana C, Basar S, Jackson BL, Niraj G. Ultrasound guided continuous transmuscular quadratus lumborum analgesia for open renal surgery: a case series. J Clin Anesth. 2017;42:100–1.CrossRefPubMed Warusawitharana C, Basar S, Jackson BL, Niraj G. Ultrasound guided continuous transmuscular quadratus lumborum analgesia for open renal surgery: a case series. J Clin Anesth. 2017;42:100–1.CrossRefPubMed
15.
Zurück zum Zitat Nielsen S, Degenhardt L, Hoban B, Gisev N. A synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiol Drug Saf. 2016;25(6):733–7.CrossRefPubMed Nielsen S, Degenhardt L, Hoban B, Gisev N. A synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiol Drug Saf. 2016;25(6):733–7.CrossRefPubMed
16.
Zurück zum Zitat Krohg A, Ullensvang K, Rosseland LA, Langesaeter E, Sauter AR. The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: a randomized clinical trial. Anesth Analg. 2018;126(2):559–65.CrossRefPubMed Krohg A, Ullensvang K, Rosseland LA, Langesaeter E, Sauter AR. The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: a randomized clinical trial. Anesth Analg. 2018;126(2):559–65.CrossRefPubMed
17.
Zurück zum Zitat Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. Biomed Res Int. 2017;2017:2752876.CrossRefPubMedPubMedCentral Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. Biomed Res Int. 2017;2017:2752876.CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat La Colla L, Uskova A, Ben-David B. Single-shot quadratus lumborum block for postoperative analgesia after minimally invasive hip arthroplasty: a new alternative to continuous lumbar plexus block? Reg Anesth Pain Med. 2017;42(1):125–6.CrossRefPubMed La Colla L, Uskova A, Ben-David B. Single-shot quadratus lumborum block for postoperative analgesia after minimally invasive hip arthroplasty: a new alternative to continuous lumbar plexus block? Reg Anesth Pain Med. 2017;42(1):125–6.CrossRefPubMed
19.
Zurück zum Zitat 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(6):129–31.CrossRefPubMed 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(6):129–31.CrossRefPubMed
20.
Zurück zum Zitat 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(3):141–8.CrossRefPubMed 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(3):141–8.CrossRefPubMed
22.
Zurück zum Zitat 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(3):387–94.CrossRefPubMed 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(3):387–94.CrossRefPubMed
23.
Zurück zum Zitat 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(1):73–9.CrossRefPubMed 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(1):73–9.CrossRefPubMed
24.
Zurück zum Zitat Dam M, Moriggl B, Hansen CK, Hoermann R, Bendtsen TF, Borglum J. The pathway of injectate spread with the transmuscular quadratus lumborum block: a cadaver study. Anesth Analg. 2017;125(1):303–12.CrossRefPubMed Dam M, Moriggl B, Hansen CK, Hoermann R, Bendtsen TF, Borglum J. The pathway of injectate spread with the transmuscular quadratus lumborum block: a cadaver study. Anesth Analg. 2017;125(1):303–12.CrossRefPubMed
Metadaten
Titel
The effects of transmuscular quadratus lumborum blocks on postoperative pain in arthroscopic hip surgery: a cohort analysis
verfasst von
Sakura Kinjo
Kerstin Kolodzie
Katherine Dong
Alan L. Zhang
Publikationsdatum
01.07.2019
Verlag
Springer Japan
Erschienen in
Journal of Anesthesia / Ausgabe 4/2019
Print ISSN: 0913-8668
Elektronische ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-019-02659-9

Weitere Artikel der Ausgabe 4/2019

Journal of Anesthesia 4/2019 Zur Ausgabe

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.