Postoperative Pain Treatment With Transmuscular Quadratus Lumborum Block and Fascia Iliaca Compartment Block in Patients Undergoing Total Hip Arthroplasty

A Randomized Controlled Trial

Qin Xia; Wenping Ding; Chao Lin; Jiayi Xia; Yahui Xu; Mengxing Jia

Disclosures

BMC Anesthesiol. 2021;21(188) 

In This Article

Results

Between November 2019 and August 2020, 76 subjects were screened for study participation. Of these, 54 subjects were included and randomly assigned to receive either T-QLB (n = 27) or T-QLB combined with FICB (n = 27). Among them, three subjects had a sensory block score of 2 after performing the block, and one subject subjects were transferred to the ICU for further treatment after surgery (Figure 3). Eventually, fifty subjects completed the study and were analyzed as per-protocol (24 in group Q, 26 in group QF). The patient demographics and surgery time in the two groups were comparable (Table 1). There was no significant difference between the two groups regarding the incidence of PONV (P > 0.05) (Table 2). We did not notice any relevant complications, such as cardio-cerebrovascular complications, hypotension, or urinary retention, among the patients.

Figure 3.

Consolidated Standards of Reporting Trials (CONSORT) flow diagram

Opioid Consumption

Compared with group Q, the intraoperative dosage of remifentanil and cumulative sufentanil consumption in group QF were significantly lower in the first 24 h after surgery (P < 0.001) (Table 2). The LMM was used to examine the changes in cumulative sufentanil consumption over the first 24 h after the operation. The time-by-group interaction was statistically significant (P = 0.022, LMM). There was a significant difference in sufentanil consumption between the two groups (P < 0.001, LMM), and the sufentanil consumption in group QF was less than that in group Q at 6–12 and 12–18 h postoperatively (P = 0.044 and P < 0.001, respectively, LMM). Moreover, the number of people requiring rescue analgesia in group QF was fewer than that in group Q (P < 0.001).

Pain Intensity

The pain scores at rest and movement for different time points are shown in Table 3. The change in the NRS scores over time in group QF was significantly different from the change in group Q both at rest and during movement (P < 0.001 and P < 0.001, respectively, LMM). Separate analyses per time point showed that, compared with group Q, the NRS scores at rest in group QF were significantly lower at 6, 12, and 24 h after surgery (P = 0.006, P < 0.001, and P < 0.021, respectively, LMM) (Figure 4a), and the NRS scores during movement were significantly lower at 6, 12, 18, and 24 h after surgery in group QF than in group Q (P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively, LMM) (Figure 4b).

Figure 4.

Numeric Rating Scores at rest (left) and during movement (right). NRS, numeric rating scores. Data are expressed as median and interquartile range. * : P < 0.05

Time to the First Analgesic Requirement

Kaplan–Meier survival curves of elapsed time showed that the time between completion of the block and the time to the first analgesic requirement was significantly longer in group QF than in group Q (P < 0.001) (Figure 5). In addition, three of 26 patients distributed to group QF did not need additional opioid analgesia during the first 24 h after surgery.

Figure 5.

Kaplan–Meier curves for time to first opioid request

Range of Motion

The maximal flexion (Figure 6a) and abduction (Figure 6b) ROM of the hip joint are shown in Table 4. The change over time in group QF was significantly different from the change in group Q both at extension and abduction (P < 0.001 and P < 0.001, respectively, LMM). Compared with group Q, the ROM was increased in group QF at the time of each clinical evaluation time.

Figure 6.

The maximum flexion (left) and abduction (right) ROM of the hip joint at 12 h, 24 h, 48 h and 72 h after surgery. ROM, range of movement. Data are expressed as mean ± SD. * : P < 0.05

Quality of Recovery

The preoperative QoR-15 score in the two groups was not statistically significant. The increase in the Qor-15 score in group QF differed significantly from the change in group Q over the study period of 48 h (P < 0.001, LMM). The QoR-15 score of patients were significantly higher in group QF at 24 h and 48 h than in group Q (P < 0.001 and P < 0.001, respectively, LMM) (Table 4).

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