Preoperative Quadratus Lumborum Block Reduces Opioid Requirements in the Immediate Postoperative Period Following Hip Arthroscopy: A Randomized, Blinded Clinical Trial.

Autor:	Wilson SH; Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A.. Electronic address: wilsosh@musc.edu., George RM; Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A., Matos JR; Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A., Wilson DA; Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, U.S.A., Johnson WJ; College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A., Woolf SK; Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
Jazyk:	angličtina
Zdroj:	Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association [Arthroscopy] 2022 Mar; Vol. 38 (3), pp. 808-815. Date of Electronic Publication: 2021 Jul 31.
DOI:	10.1016/j.arthro.2021.07.029
Abstrakt:	Purpose: To examine acute postoperative opioid consumption in patients undergoing hip arthroscopy and randomized to either receive a preoperative lateral quadratus lumborum block or sham injection. Methods: This trial randomized 46 subjects undergoing hip arthroscopy with a single surgeon to receive a preoperative lateral quadratus lumborum block (40 mL, ropivacaine 0.25%) or sham injection. The primary outcome was postoperative opioid consumption in patients with and without a block. All opioid medications were converted to morphine milligram equivalents for comparisons. Categorical data were compared with χ 2 tests and Fisher exact tests where appropriate. Continuous data were compared with 2-sided t-test and Wilcoxon rank-sum tests. Results: Forty-six subjects scheduled for elective hip arthroscopy were successfully consented and randomized. Demographic and clinical characteristics did not differ. Postoperative opioid consumption decreased 28.3% in patients who received a preoperative lateral quadratus lumborum block (P = .04). Total perioperative opioid consumption (intraoperative and postoperative combined) was reduced 20% in the block group; however, this did not achieve statistical significance (P = .05). Three subjects in the sham group (12.5%) required unblinding for a rescue block in the postoperative anesthetic care unit (PACU) for uncontrolled pain despite systemic analgesics. While cold sensation was decreased postoperatively over the abdomen (P < .001) and anterior thigh (P = .03) in the block group, other PACU variables did not differ, including VAS pain scores, motor function, side effects, PACU duration, and patient satisfaction. Conclusions: Opioid consumption was reduced in patients who received a preoperative lateral quadratus lumborum block combined with a standardized, multimodal protocol as compared with patients who did not receive a block. Our findings support the growing evidence that quadratus lumborum blocks are an effective component of multimodal analgesia options for patients undergoing elective hip arthroscopy. Level of Evidence: Level I, randomized controlled trial. (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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