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Postoperative analgesic effectiveness of ultrasound-guided transmuscular quadratus lumborum block in congenital hip dislocation surgery

A randomized controlled study

Postoperative analgetische Wirksamkeit einer ultraschallgeführten transmuskulären Quadratus-lumborum-Blockade bei Operation einer kongenitalen Hüftluxation

Eine randomisierte kontrollierte Studie

Der Anaesthesist volume 70, pages 53–59 (2021)Cite this article

Abstract

Background/objective

Congenital hip dysplasia (CHD) defines a spectrum of pathologies in which the acetabulum and proximal femur of babies and children abnormally develop. Open surgery in congenital hip dysplasia leads to severe postoperative pain. The aim of this study was to evaluate the effectiveness of ultrasound-guided quadratus lumborum block (QLB) in pediatric patients undergoing surgery for congenital hip dysplasia.

Material and methods

Following ethical board approval, 40 children aged between 1–5 years undergoing surgery for congenital hip dysplasia were randomized into two groups. Patients (n = 20) received ultrasound guided quadratus lumborum block (group QLB) using 0.5 mL/kg body weight 0.25% bupivacaine preoperatively. The same standard postoperative analgesia protocol was used in both groups. Pain scores, parental satisfaction, requirement for ibuprofen and opioids were recorded. Pain was measured using the face, legs, activity, crying, consolability (FLACC) scale.

Results

The FLACC scores were lower at 30min and 1h, 2h, 4h, 6h, 12h and 24h in the QLB group when compared to the control group (p < 0.05). The requirement for rescue opioid analgesia was statistically significantly higher in the control group when compared to the QLB group (15/20 vs. 3/20, p < 0.001). Rate of ibuprofen usage in the ward was higher in the control group when compared to the QLB group (14/20 vs. 4/20, p = 0.004). Parental satisfaction was higher in the QLB group (p < 0.001).

Conclusion

Ultrasound-guided quadratus lumborum block reduces pain scores and analgesic requirements following congenital hip dysplasia surgery.

Zusammenfassung

Hintergrund/Ziel

Angeborene Hüftdysplasie (CHD) definiert ein Spektrum von Pathologien, bei denen sich das Acetabulum und das proximale Femur von Säuglingen und Kleinkindern abnormal entwickeln. Eine offene Operation bei angeborener Hüftdysplasie führt zu starken postoperativen Schmerzen. Ziel dieser Studie ist es, die Wirksamkeit der ultraschallgeführten Quadratus-lumborum-Blockade (QLB) bei pädiatrischen Patienten zu bewerten, die sich einer Operation wegen angeborener Hüftdysplasie unterziehen.

Material und Methoden

Nach der Genehmigung durch die Ethikkommission wurden 40 Kinder im Alter zwischen 1 und 5 Jahren, bei denen eine die operative Behandlung einer angeborenen Hüftdysplasie geplant war, in 2 Gruppen randomisiert. Patienten in der Gruppe QLB (n = 20) erhielten präoperativ eine ultraschallgeführte QLB mit 0,5 ml/kg/% 0,25 Bupivacain. In beiden Gruppen wurde das gleiche Standardprotokoll für die postoperative Analgesie verwendet. Schmerzwerte, elterliche Zufriedenheit, Bedarf an Ibuprofen und Opioiden wurden erfasst. Der Schmerz wurde unter Verwendung der FLACC-Skala (Gesicht, Beine, Aktivität, Weinen, Trost) gemessen.

Ergebnisse

Die FLACC-Werte der QLB-Gruppe waren in der 30. Minute sowie in der 1., 2., 4., 6., 12. und 24. Stunde im Vergleich zur Kontrollgruppe niedriger (p < 0,05). Der Bedarf an Rescue-Opioid-Analgesie war in der Kontrollgruppe im Vergleich zur QLB-Gruppe statistisch signifikant höher (15/20 vs. 3/20; p < 0,001). Die Ibuprofen-Verwendungsrate auf der Station war in der Kontrollgruppe im Vergleich zur QLB-Gruppe höher (14/20 vs. 4/20, p = 0,004). Die elterliche Zufriedenheit war in der QLB-Gruppe höher (p < 0,001).

Schlussfolgerung

Die ultraschallgeführte Quadratus-lumborum-Blockade reduziert die Schmerzwerte und den Bedarf an Analgetika nach operativer Behandlung der angeborenen Hüftdysplasie.

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Funding

The authors have no sources of funding to declare for this manuscript.

Author information

Affiliations

  1. Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, 25070, Erzurum, Turkey

    Elif Oral Ahiskalioglu,  Ali Ahiskalioglu MD, Kubra Selvitopi, Ugur Peksoz, Muhammed Enes Aydin, Irem Ates & Mine Celik

  2. Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, 25240, Erzurum, Turkey

    Ali Ahiskalioglu MD, Muhammed Enes Aydin & Mine Celik

Authors
  1. Elif Oral Ahiskalioglu
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  2. Ali Ahiskalioglu MD
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  3. Kubra Selvitopi
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  4. Ugur Peksoz
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  5. Muhammed Enes Aydin
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  6. Irem Ates
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  7. Mine Celik
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Contributions

EOA: conceptualization, design, supervision, validation, formal analysis, block performance and writing of the original draft. AA: design, project administration, data curation, block performance and writing of the original draft. KS: project administration, data curation, writing of the review and editing. UP: data curation. MEA: writing of the review and editing, project administration. IA: conceptualization, design, resources MC: supervision, validation, writing, review and editing. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Ali Ahiskalioglu MD.

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Conflict of interest

E. Oral Ahiskalioglu, A. Ahiskalioglu, K. Selvitopi, U. Peksoz, M.E. Aydin, I. Ates and M. Celik declare that they have no competing interests.

Ethical standards

Ethical approval was obtained for this prospective randomized study from the Ethics Committee of Ataturk University (15/02/2018-2-1). The study was registered with a clinical trial registry (ClinicalTrials.gov, identifier NCT04212832).

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Oral Ahiskalioglu, E., Ahiskalioglu, A., Selvitopi, K. et al. Postoperative analgesic effectiveness of ultrasound-guided transmuscular quadratus lumborum block in congenital hip dislocation surgery. Anaesthesist 70, 53–59 (2021). https://doi.org/10.1007/s00101-021-00913-y

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  • DOI: https://doi.org/10.1007/s00101-021-00913-y

Keywords

  • Hip dislocation surgery
  • Quadratus lumborum block
  • Postoperative analgesia
  • Ultrasound
  • Pediatric

Schlüsselwörter

  • Operation einer Hüftluxation
  • Quadratus-lumborum-Blockade
  • Postoperative Analgesie
  • Ultraschall
  • Pädiatrisch