Comparison of continuous transmuscular quadratus lumborum block and continuous psoas compartment block for posterior total hip arthroplasty : A randomised controlled trial
Copyright: © 2023 Indian Journal of Anaesthesia..
Background and Aims: Analgesia for hip surgery involves cutaneous anaesthesia at the site of the skin incision and the anterior hip capsule. This study aimed to compare continuous ultrasound (US)-guided transmuscular quadratus lumborum block (TQLB) with psoas compartment block (PCB) for analgesia in patients undergoing total hip arthroplasty (THA) under general anaesthesia (GA).
Methods: This randomised, observer-blinded trial included 18-70-year-old American Society of Anesthesiologists physical status I-III patients undergoing THA under GA with either US-guided continuous TQLB or PCB. Primary objectives included a visual analogue scale (VAS; 0-100 mm) at rest and mobilisation at 6 h postoperatively (analysed by intention to treat and per protocol) using a non-inferiority margin of 20 mm. Secondary objectives included VAS at other time points, 24-h fentanyl consumption (analysed using the Wilcoxon rank-sum test), sensory dermatomes anaesthetised, motor weakness 30 min after block, and haemodynamic response to skin incision (analysed using the Chi-squared or Fisher's exact test). A P value less than 0.05 was considered statistically significant.
Results: VAS (0-100 mm) score at 6 h on rest was 25.34 ± 14.25 and 27.3 ± 9.6, mean difference (MD) was 1.9 [-3.3, 7.1] and at movement was 35.1 ± 23.0 and 38.6 ± 17.0, MD was 3.5 [-5.2, 12.2], in the PCB (n = 29) and QLB (n = 30) groups, respectively (i.e. less than the non-inferiority margin). However, VAS (rest) at 1, 12, and 24 h postoperatively and median (IQR) 24-h fentanyl consumption was significantly higher in the QLB group (1212.5 [300-2345] μg] when compared to the PCB group (635 [100-1645] μg; P = 0.0004).
Conclusion: Though statistically, continuous QLB was non-inferior to continuous PCB for pain at rest and mobilisation at 6-hours postoperatively, a higher 24-hour perioperative fentanyl consumption and VAS show that QLB was clinically inferior to PCB.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:67 |
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| Enthalten in: |
Indian journal of anaesthesia - 67(2023), 6 vom: 01. Juni, Seite 530-536 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Balakrishnan, Arjun [VerfasserIn] |
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| Links: |
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| Themen: |
Arthroplasty |
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| Anmerkungen: |
Date Revised 22.07.2023 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.4103/ija.ija_863_22 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM359768466 |
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| 100 | 1 | |a Balakrishnan, Arjun |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Comparison of continuous transmuscular quadratus lumborum block and continuous psoas compartment block for posterior total hip arthroplasty |b A randomised controlled trial |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Revised 22.07.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a Copyright: © 2023 Indian Journal of Anaesthesia. | ||
| 520 | |a Background and Aims: Analgesia for hip surgery involves cutaneous anaesthesia at the site of the skin incision and the anterior hip capsule. This study aimed to compare continuous ultrasound (US)-guided transmuscular quadratus lumborum block (TQLB) with psoas compartment block (PCB) for analgesia in patients undergoing total hip arthroplasty (THA) under general anaesthesia (GA) | ||
| 520 | |a Methods: This randomised, observer-blinded trial included 18-70-year-old American Society of Anesthesiologists physical status I-III patients undergoing THA under GA with either US-guided continuous TQLB or PCB. Primary objectives included a visual analogue scale (VAS; 0-100 mm) at rest and mobilisation at 6 h postoperatively (analysed by intention to treat and per protocol) using a non-inferiority margin of 20 mm. Secondary objectives included VAS at other time points, 24-h fentanyl consumption (analysed using the Wilcoxon rank-sum test), sensory dermatomes anaesthetised, motor weakness 30 min after block, and haemodynamic response to skin incision (analysed using the Chi-squared or Fisher's exact test). A P value less than 0.05 was considered statistically significant | ||
| 520 | |a Results: VAS (0-100 mm) score at 6 h on rest was 25.34 ± 14.25 and 27.3 ± 9.6, mean difference (MD) was 1.9 [-3.3, 7.1] and at movement was 35.1 ± 23.0 and 38.6 ± 17.0, MD was 3.5 [-5.2, 12.2], in the PCB (n = 29) and QLB (n = 30) groups, respectively (i.e. less than the non-inferiority margin). However, VAS (rest) at 1, 12, and 24 h postoperatively and median (IQR) 24-h fentanyl consumption was significantly higher in the QLB group (1212.5 [300-2345] μg] when compared to the PCB group (635 [100-1645] μg; P = 0.0004) | ||
| 520 | |a Conclusion: Though statistically, continuous QLB was non-inferior to continuous PCB for pain at rest and mobilisation at 6-hours postoperatively, a higher 24-hour perioperative fentanyl consumption and VAS show that QLB was clinically inferior to PCB | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Arthroplasty | |
| 650 | 4 | |a nerve block | |
| 650 | 4 | |a pain | |
| 650 | 4 | |a postoperative analgesia | |
| 650 | 4 | |a psoas compartment block | |
| 650 | 4 | |a transmuscular quadratus lumborum block | |
| 650 | 4 | |a ultrasonography | |
| 700 | 1 | |a Chhabra, Anjolie |e verfasserin |4 aut | |
| 700 | 1 | |a Kumar, Ajeet |e verfasserin |4 aut | |
| 700 | 1 | |a Talawar, Praveen |e verfasserin |4 aut | |
| 700 | 1 | |a Bhoi, Debesh |e verfasserin |4 aut | |
| 700 | 1 | |a Garg, Heena |e verfasserin |4 aut | |
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