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

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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.

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References

  1. 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.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  CAS  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. Biomed Res Int. 2017;2017:2752876.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  CAS  PubMed  Google Scholar 

  21. Elsharkawy H. Quadratus lumborum blocks. Adv Anesth. 2017;35(1):145–57.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. 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.

    Article  CAS  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

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Acknowledgements

Authors thank Charles McCulloch, PhD, Department of Epidemiology and Biostatistics at UCSF, for his statistical advice and guidance.

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Authors and Affiliations

  1. Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, San Francisco, CA, 94143-0648, USA

    Sakura Kinjo & Kerstin Kolodzie

  2. University of Central Florida, College of Medicine, Orlando, FL, USA

    Katherine Dong

  3. Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA

    Alan L. Zhang

Authors
  1. Sakura Kinjo
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  2. Kerstin Kolodzie
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  3. Katherine Dong
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  4. Alan L. Zhang
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Corresponding author

Correspondence to Sakura Kinjo.

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Conflict of interest

Sakura Kinjo, Kerstin Kolodzie, Katherine Dong and Alan L. Zhang have no conflict of interest.

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Kinjo, S., Kolodzie, K., Dong, K. et al. The effects of transmuscular quadratus lumborum blocks on postoperative pain in arthroscopic hip surgery: a cohort analysis. J Anesth 33, 516–522 (2019). https://doi.org/10.1007/s00540-019-02659-9

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  • DOI: https://doi.org/10.1007/s00540-019-02659-9

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