3
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Continuous quadratus lumborum block as part of multimodal analgesia after total hip arthroplasty: a case report

      case-report

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Commonly used epidural or systemic analgesics for pain control after hip surgery carry risk for potential adverse effects. In contrast, the quadratus lumborum block (QLB) utilizes a simple and easy fascial plane technique and provides a wide area of sensory blockade. Thus, the QLB may be beneficial as analgesia after total hip arthroplasty.

          Case

          Here, we report the case of an 83-year-old man who received a continuous transmuscular QLB as part of a multimodal analgesia after hardware removal and total hip arthroplasty. The patient received a continuous infusion of 0.2% ropivacaine at 8 ml/h through an indwelling catheter in addition to patient-controlled analgesia with intravenous fentanyl and oral celecoxib. The patient’s pain scores did not exceed 4, and no additional analgesics were required until postoperative day 5.

          Conclusions

          Transmuscular QLB may be a suitable option for multimodal analgesia after total hip arthroplasty.

          Related collections

          Most cited references13

          • Record: found
          • Abstract: found
          • Article: not found

          Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery.

          Continuous passive motion after major knee surgery optimizes the functional prognosis but causes severe pain. The authors tested the hypothesis that postoperative analgesic techniques influence surgical outcome and the duration of convalescence. Before standardized general anesthesia, 56 adult scheduled for major knee surgery were randomly assigned to one of three groups, each to receive a different postoperative analgesic technique for 72 h: continuous epidural infusion, continuous femoral block, or intravenous patient-controlled morphine (dose, 1 mg; lockout interval, 7 min; maximum dose, 30 mg/4 h). The first two techniques were performed using a solution of 1% lidocaine, 0.03 mg/ml morphine, and 2 microg/ml clonidine administered at 0.1 ml x kg(-1) x h(-1). Pain was assessed at rest and during continuous passive motion using a visual analog scale. The early postoperative maximal amplitude of knee flexion was measured during continuous passive motion at 24 h and 48 h and compared with the target levels prescribed by the surgeon. To evaluate functional outcome, the maximal amplitudes were measured again on postoperative day 5, at hospital discharge (day 7), and at 1- and 3-month follow-up examinations. When the patients left the surgical ward, they were admitted to a rehabilitation center, where their length of stay depended on prospectively determined discharge criteria The continuous epidural infusion and continuous femoral block groups showed significantly lower visual analog scale scores at rest and during continuous passive motion compared with the patient-controlled morphine group. The early postoperative knee mobilization levels in both continuous epidural infusion and continuous femoral block groups were significantly closer to the target levels prescribed by the surgeon than in the patient-controlled morphine group. On postoperative day 7, these values were 90 degrees (60-100 degrees)(median and 25th-75th percentiles) in the continuous epidural infusion group, 90 degrees (60-100 degrees) in the continuous femoral block group, and 80 degrees (60-100 degrees) in the patient-controlled morphine group (P < 0.05). The durations of stay in the rehabilitation center were significantly shorter: 37 days (range, 30-45 days) in the continuous epidural infusion group, 40 days (range, 31-60 days) in the continuous femoral block group, and 50 days (range, 30-80 days) in the patient-controlled morphine group (P < 0.05). Side effects were encountered more frequently in the continuous epidural infusion group. Regional analgesic techniques improve early rehabilitation after major knee surgery by effectively controlling pain during continuous passive motion, thereby hastening convalescence.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks.

            Posterior variants of abdominal wall block include the quadratus lumborum type I, quadratus lumborum type II and quadratus lumborum transmuscular blocks. Our objectives were to compare the spread of injectate and nerve involvement, after conducting blocks using ultrasound guidance in soft embalmed cadavers.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers

              We performed bilateral transmuscular quadratus lumborum blocks in six cadavers using iodinated contrast and methylene blue. Computed tomography imaging was performed in four cadavers and anatomical dissection was completed in five. This demonstrated spread to the lumbar paravertebral space in 63% of specimens, laterally to the transversus abdominis muscle in 50% and caudally to the anterior superior iliac spine in 63% of specimens. There was no radiographic evidence of spread to the thoracic paravertebral space. Anatomical dissection revealed dye staining of the upper branches of the lumbar plexus and the psoas major muscle in 70% of specimens. Further clinical studies are required to confirm if the quadratus lumborum block might be a suitable alternative to lumbar plexus block.
                Bookmark

                Author and article information

                Journal
                Korean J Anesthesiol
                Korean J Anesthesiol
                KJA
                Korean Journal of Anesthesiology
                Korean Society of Anesthesiologists
                2005-6419
                2005-7563
                April 2020
                17 May 2019
                : 73
                : 2
                : 158-162
                Affiliations
                [1 ]Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
                [2 ]Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
                Author notes
                Corresponding author: Seunguk Bang, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Korea Tel: +82-42-220-9046, Fax: +82-42-220-3500 Email: seungukb@ 123456naver.com
                Author information
                http://orcid.org/0000-0002-5261-2135
                http://orcid.org/0000-0001-6609-7691
                http://orcid.org/0000-0001-6487-2914
                http://orcid.org/0000-0002-2313-3258
                http://orcid.org/0000-0002-2749-1941
                Article
                kja-d-19-00016
                10.4097/kja.d.19.00016
                7113169
                31096729
                82b1cdf1-9581-4911-97ab-d1fe9fe90f54
                Copyright © The Korean Society of Anesthesiologists, 2020

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 January 2019
                : 30 April 2019
                : 14 May 2019
                Categories
                Case Report

                Anesthesiology & Pain management
                analgesia,arthroplasty,catheters,nerve block,pain,ropivacaine,ultrasonography

                Comments

                Comment on this article