Effects Of Ultrasound-guided Posterior Quadratus Lumborum Block And Cocktail Therapy For Postoperative Analgesia In Old Patients Undergoing Total Hip Arthroplasty

ObjectiveThis study aims to compare the effect of ultrasound-guided posterior quadratus lumborum block and cocktail therapy for postoperative analgesia in old patients undergoing total hip arthroplasty.MethodsThe study is a randomized,single-blind controlled trial.A total of 75 patients scheduled for total hip arthroplasty surgery were included in this trial.The research object are patients who were enrolled between May 2018 and December 2018 in Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University.And the inclusion criteria were age between 60 and 80 years and an ASA physical status ?,? or ?.After written informed consent,the 75 patients were randomly allocated to the quadratus lumborum group(QLB-group),the cocktail therapy group(CT-group),or the control group(C-group),with an allocation ratio of 1:1:1.For patients of the QLB-group,a single shot QLB was applied under ultrasound guidance 30 minutes before induction of anesthesia on the ill side,and 1.3 mg/kg of ropivacaine 0.375%were injected using a 22 G needle of 50 mm length.Patients in the CT-group received an 100 ml multimode drug(composed of 150 mg Ropivacaine(20 ml),5mg Morphine,40 mg Methylprednisolone,0.3 ml Epinephrine,and 80 ml Saline).And all of the drags were injected into peri-articular soft tissue of the patients before suturing the skin.Patients in the control group did not receive any treatment before the surgery.Irrespective of the group allocation,all patients received a combination of the following IV analgesics:dizosin 0.15 mg/kg,flurbiprofen ester injection 1.5 mg/kg for postoperative pain control,thirty minutes before the end of surgery.All patients received 0.05 mg/kg Trotsky ten minutes before the end of surgery.In addition,each patient received Patient-controlled Intravenous Analgesia(PCIA)with sufentanil(250 ug/250 ml,rate 0,bolus 2 ml,locktime 5 minutes,no more than 10 ml one hour).The main study indicators included three variables:the sufentanil consumption in the first 48 hours postoperatively(T1-T6),the everity of postoperative pain as evaluated with the VAS during the period of T1-T6,both at rest and during coughing.And the secondary study indicators consist of seven variables:the number of patients for rescue pain relief by PCIA during 48h after surgery;the first time to use the PCIA;the time to recovery of intestinal function;the PONV incidence and documenting the presence/absence of vomiting during the first 48 hours;the first fart's time;length of hospital stay;the overall satisfaction of patients.ResultsThe M(Qi;Q3)was used to compare the 48-hour cumulative sufentanil intake between the three groups.The amount of sufentanil consumption of QLB group during Ti-T6 postoperatively was 0(0;0),0(0;0),0(0;2),0(0;2),0(0;0)and 0(0;0),respectively.The amount of sufentanil consumption of CT-group during T1-T6 postoperatively was 0(0;0),0(0;0),0(0;0),0(0;2),0(0;2)and 0(0;0),respectively.The amount of C group was 0(0;0),0(0;0.5),4(6;6),6(8;10),4(4;6)and 2(2;4),respectively.The amount of sufentanil consumption during T1-T6 was not significantly different between the QLB-group and the CT-group(P=1,1,0.052,0.665,0.072,0.226>0.05).The amount of sufentanil consumption during T1 was not significantly different between the QLB-group and the CT-group(P=1).The amount during T2-T6 was significantly lower in the QLB-group than in the C-group.The values of P were 0.009,<0.001,<0.001,<0.001,<0.001,all less than 0.05.The amount during T1 was not significantly different between the CT-group and the C-group.The value of P was 1.The amount during T2-T6 was significantly lower in the CT-group than in the C-group.The values of P were 0.009,<0.001,<0.001,<0.001,<0.001,were all less than 0.05.The(x ± s)was used to compare the static VAS pain score between the three groups.The static VAS pain score of QLB-group during T1-T6 postoperatively were 1.08±0.27,1.32±0.47,1.56±0.50,1.68±0.68,1.32±0.47 and 1.08±0.27,respectively.The static VAS pain score of CT-group were 0.92±0.27,1.28±0.45,1.56±0.64,1.76±0.65,1.48±0.50 and 1.20 ± 0.49 respectively.The static VAS pain score of C-group were 2.95±0.80,3.25±0.83,3.40±0.80,3.65±0.96,3.25±0.83 and 2.95±0.74.The static VAS pain score during Ti-T6 were not significantly different between the QLB-group and the CT-group.The values of P were 0.057,0.763,1,0.678,0.257,0.389,were all bigger than 0.05.The static VAS pain score of the QLB-group during T1-T6 were significantly lower than the C-group values.The specific values of P were<0.001,<0.001,<0.001,<0.001,<0.001,<0.001,were all less than 0.05.And the CT-group static VAS pain score during T1-T6 were significantly lower than the C-group values.The values of P were<0.001,<0.001,<0.001,<0.001,<0.001,<0.001,were all less than 0.05.The dynamic VAS pain score of QLB-group during T1-T6 postoperatively were 1.56±0.50,1.56±0.50,2.40±0.63,2.72±0.87,2.48±0.57 and 2.08±0.27,respectively.The dynamic VAS pain score of CT-group were 1.44±0.50,1.80±0.40,2.48±0.64,2.80±0.80,2.68±0.68 and 2.32±0.55,respectively.The dynamic VAS pain score of C-group were 3.40±0.73,3.60±0.97,4.75±0.83,5.80±0.75,5.35±0.91 and 4.60±0.66.The dynamic VAS pain score during T1-T6 was not significantly different between the QLB-group and the CT-group.The values of P were 0.406,0.071,0.665,0.742,0.275,0.060,were all bigger than 0.05.The dynamic VAS pain score of the QLB-group during T1-T6 was significantly lower than that in the C-group.The values of P were<0.001,<0.001,<0.001,<0.001,<0.001,<0.001,were all less than 0.05.The dynamic VAS pain score of the CT-group during T1-T6 was significantly lower than that in the C-group.The values of P were<0.001,<0.001,<0.001,<0.001,<0.001,<0.001,were all less than 0.05.The M(Q1;Q3)was used to characterize the first generation time of the analgesic request among the three groups.The first generation time of the analgesic request of the QLB-group was 11(12;12)h.The time of CT-group was 10(13;13)h.The time of C-group was 8(7;9)h.The first generation time of the analgesic request was not significantly different between the QLB-group and the CT-group(P=0.605>0.05).The time was significantly later both in the QLB-group and CT-group than in the C-group(P=0.003<0.05).The percentage(%)was used to characteriaze the usage rates of PCIA.The usage rates of PCIA of QLB-group,CT-group and the C-group were 44%,52%and 92%,respectively.The usage rates of PCIA was not significantly different between the QLB-group and the CT-group(P=0.258>0.05).The usage rates of PCIA was significantly smaller both in the QLB-group and CT-group than in the C-group(P=0.002<0.05).The x ± s was used to compare the first generation time of the flatus.The first flatus time of QLB-group,CT-group and the C-group were 6.32±1.83 h,9.12±1.86 h and 10.50±2.33 h,respectively.The first flatus time of the QLB-group was significantly smaller than that in the CT-group and C-group.The values of P were<0.001,<0.001,were all less than 0.05.The first flatus time was not significantly different between the CT-group and the C-group(P=0.057>0.05).The percentage(%)was used to compare the incidence of adverse reactions.The incidence of postoperative nausea and vomiting(PONY)of QLB-group,CT-group and C-group were 24%,28%and 52%,respectively.The incidence of pruritus of QLB-group,CT-group and C-group were 4%,8%and 12%,respectively.The incidence of urinary retention of QLB-group,CT-group and C-group were 0%,0%and 0%,respectively.The incidence of respiratory depression of QLB-group,CT-group and C-group were 0%,0%and 0%.The incidence of adverse reactions of three groups was not significantly different(P>0.05).The x ± s was used to compare the length of hospital stay.The length of hospital stay of QLB-group,CT-group and C-group were 10.84±4.64,12.08±4.87 and 14.25±5.12.The length of hospital stay of three groups was not significantly different(P>0.05).The percentage(%)was used to compare the satisfaction of patients.The rate of the very satisfaction of QLB-group,CT-group and C-group were 72%,64%and 36%,respectively.The rate of the satisfaction were 20%,20%and 44%,respectively.The rate of normal were 8%,16%and 12%,respectively.The rate of not satisfaction were 0%,0%and 8%.The rate of satisfaction of QLB-group and CT-group was significantly higher than the C-group(P<0.05).ConclusionThe QLB was not superior with respect to postoperative analgesia when compared to the cocktail therapy.Both the QLB and cocktail therapy were superior with respect to postoperative analgesia when compared with the control group in old patients undergoing total hip arthroplasty.The time of intestinal function recovery about the QLB group was earlier than that of the cocktail therapy group.When compared with the cocktail therapy,the QLB method was better agree with the ERAS concept.Given the superior efficacy of the QLB in the recovery of intestinal function,we suggest that the old patients undergoing total hip arthroplasty choose the QLB for postoperative analgesia.