Effect Of Quadratus Lumborum Block On Acute Pain After Total Hip Arthroplasty

BackgroundIn recent years,with the promotion of the enhanced recovery after surgery(ERAS)and the requirement for early functional exercise on patients after hip arthroplasty,how to use different anesthesia methods in combination had become a research hotspot in anesthesiology.The epidural anesthesia,fasciailiaca compartment block,quadratus lumborum block,femoral block,obturator nerve block and lateral femoral cutaneous nerve block were common in clinic and used for analgesia after hip arthroplasty.But there was no a nerve block method could be used as the "gold standard" for analgesia after hip arthroplasty.There had been several randomized controlled trials comparing quadratus lumborum block with fasciailiaca compartment block and femoral block for analgesia after hip arthroplasty under subarachnoid block.Few controlled studies had been conducted on the intraoperative and postoperative analgesia of quadratus lumborum block combined with general anesthesia using endotracheal intubation in total hip arthroplasty,as well as the effects of quadratus lumborum block on stress-related inflammatory factors in organism.ObjectiveThe purpose of this study was to compare the effects of quadratus lumborum block combined with total intravenous general anesthesia(TIVA)or not.To explore the effect of ultrasound-guided quadratus lumborum block on acute pain after total hip arthroplasty,and to objectively evaluate the rationality of quadratus lumborum block for stress-related inflammatory.MethodsThirty-six patients undergoing elective unilateral total hip arthroplasty due to hip osteoarthritis were randomly divided into two groups,18 patients in each group.The control group(group C)was the group with TIVA and patient controlled intravenous analgesia(PCIA),and the experimental group(group Q)was the group that quadratus lumborum block combined with TIVA and PCIA.Two groups were compared in terms of VAS scores at rest at 0h,4h,6h,12h,24h,48h after surgery,and VAS scores during mobilization at 12h,24h,48h after surgery.Secondly,the recovery quality scores at 24h and 48h after surgery,Interleukin 6(IL-6)levels in peripheral venous blood at 24h before and after surgery,consumption of opioids during and after surgery,hip joint activities at 24h and 48h after surgery,the block range of quadratus lumborum block,the pressing times of PCIA,the length of stay,and the incidence of postoperative complications for 48h were also recorded.ResultsThere were no significant differences between the two groups of patients in their preoperative general data,indicating they were compatible(P>0.05).VAS scores at rest and during mobilization of patients in the QLB group were lower than those in the control group at all time points after surgery,the differences were statistically significant(P<0.05).The recovery quality scores in the QLB group were higher than those in the control group at 24h and 48h after surgery.The IL-6 levels at 24 h after surgery,the intraoperative total amount of sufentanil,remifentanil consumption during the operation,sufentanil consumption of PCIA,the pressing times of PCIA,the incidence of postoperative nausea and vomiting of QLB group were lower than those of control group.The differences were statistically significant(P<0.05).Compared with the control group,maximum hip flexion and abduction activity at 24h and 48h after surgery in the QLB group were increased,the differences were statistically significant(P<0.05).The highest block range of QLB group was T11?L1 and the lowest block range was L1?L2.There were no significant differences between the two groups of patients in the length of stay(P>0.05).ConclusionUltrasound-guided quadratus lumborum block combines with patient controlled intravenous analgesia can effectively relieve acute pain in patients after unilateral total hip arthroplasty.It can suppress stress-related inflammatory factors,reduce consumption of opioids and the incidence of postoperative complications.It is beneficial to the enhanced recovery of patients after surgery.