Comparative study between three approaches of ultrasound guided quadratus lumborum block for post-operative analgesia in total hip replacement with spinal anaesthesia

Main Article Content

Abdel Wahab A. S.S. Mohammed
Tamer M.A Ewieda
Wael M. Mossa
Abdelfattah M. Abdelfattah
Mohammed H. Alqassas
Ayman S. Abdelaziz Elsaily

Keywords

Ultrasound-guided quadratus lumborum block; orthopedic lower limb; subarachnoid anesthesia

Abstract

Background: Early postoperative ambulation and reduction of hospital stay necessitate efficient postoperative analgesia. Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery.
Objective: compare between different approaches of ultrasound guided quadratus lumborum block for post-operative analgesia in total hip replacement with spinal anaesthesia.
Patients and Methods: This study was conducted in Orthopedic surgery operating unit in Al-Azhar University Hospitals (Al-Hussein and Sayed Galal), and approved by the ethics committee from the Department of Anesthesia of Faculty of Medicine, Al-Azhar University. Patients gave written informed consents. A total of 80 patients undergoing total hip replacement with spinal anesthesia were enrolled in our study. Eligible patients were randomly classified into four groups; 20 patients had received lateral QLB (QLB-1), 20 patients had received posterior QLB (QLB-2), 20 patients had received transmuscular QLB (QLB-3). QL blocks were done using 20 ml of Bupivacaine 0.25 %. The remaining 20 patients had received spinal anaesthesia only (SAB) that served as control group.
Results: The time of requirement of first analgesia significantly prolonged in QLB-3 compared to QLB-1, QLB-2 and SAB control and prolonged in QLB-1 and QLB-2 than SAB control with insignificant differences between QLB1 and QLB-2. The total doses of rescue morphine were significantly lower in QLB-3 compared to QLB-1, QLB-2 and SAB control, and lower in QLB-1 and QLB-2 than SAB control with insignificant differences between QLB1 and QLB-2. VAS was significantly different among the four groups at 2, 12 and 24 hours (P <0.001) but was insignificantly different at PACU and 6 hours. VAS at 2 hours was significantly lower in QLB-3 compared to QLB1, QLB-2 and SAB Control but with insignificant differences among QLB1, QLB-2 and SAB control group. VAS at 12 and 24 hours were significantly lower in QLB-3 compared to QLB-1, QLB-2 and SAB Control and lower in QLB-1 and QLB-2 than SAB Control with insignificant differences between QLB1 and QLB-2.


Conclusion: Ultrasound guided postsurgical transmuscular approach of QLB (QLB-3) using 20 ml
0.25% bupivacaine produces more postoperative analgesic effect and less postoperative opioid
consumption when compared to posterior QLB approach (QLB-2) in patients underwent unilateral
inguinal hernia repair under general anesthesia.

Abstract 352 | pdf Downloads 218

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