Aoyama Yuki, Sakura Shinichi, Abe Shoko, Tadenuma Saki, Saito Yoji
Department of Anesthesiology, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
J Anesth. 2020 Jun;34(3):413-420. doi: 10.1007/s00540-020-02769-9. Epub 2020 Mar 30.
Continuous femoral nerve block (FNB) has been effectively used after total hip arthroplasty (THA). Recently the anterior approach to quadratus lumborum block (QLB) has been shown to produce postoperative pain relief after THA. Continuous QLB would benefit from a catheter insertion site that is farther away from the surgical site compared with continuous FNB. In this randomized controlled study, we compared analgesic effects of the two techniques in patients undergoing THA.
Thirty patients undergoing THA were randomly allocated into two groups receiving continuous QLB and FNB. Under ultrasound guidance, QLB and FNB were conducted before general anesthesia using 0.25% levobupivacaine 30 ml and 0.5% levobupivacaine 15 ml, respectively, and a catheter was introduced. Postoperatively, all patients received continuous infusion of 0.125% levobupivacaine at 4 ml/h. Postoperative measurements included visual analog scale (VAS) pain scores at rest and on movement, postoperative analgesic demands, cutaneous sensory blockade and adverse events for 48 h.
Six patients were excluded and 24 patients (13 and 11 patients in QLB group and FNB, respectively) were analyzed. VAS scores on movement at 6 h [median (IQR): 67 (41-80) and 38 (22-41) in QLB and FNB groups, respectively, p = 0.008] and 24 h [60 (40-80) and 39 (28-64) in QLB and FNB groups, respectively, p = 0.018] were lower with FNB than with QLB. QLB did not produce consistent cutaneous sensory blockade.
Analgesic effects of continuous QLB were inferior to those of continuous FNB in patients undergoing THA under the current study condition.
连续股神经阻滞（FNB）已在全髋关节置换术（THA）后得到有效应用。最近，腰方肌阻滞（QLB）的前路法已被证明可在THA后减轻术后疼痛。与连续FNB相比，连续QLB若能有一个距离手术部位更远的导管插入部位将更有益处。在这项随机对照研究中，我们比较了这两种技术在接受THA患者中的镇痛效果。
30例接受THA的患者被随机分为两组，分别接受连续QLB和FNB。在超声引导下，分别于全身麻醉前使用0.25%左旋布比卡因30 ml和0.5%左旋布比卡因15 ml进行QLB和FNB，并置入导管。术后，所有患者均以4 ml/h的速度持续输注0.125%左旋布比卡因。术后测量指标包括静息和活动时的视觉模拟评分（VAS）疼痛评分、术后镇痛需求、皮肤感觉阻滞情况以及48小时内的不良事件。
6例患者被排除，对24例患者（QLB组和FNB组分别为13例和11例）进行了分析。QLB组和FNB组在6小时[中位数（IQR）：分别为67（41 - 80）和38（22 - 41），p = 0.008]和24小时[分别为60（40 - 80）和39（28 - 64），p = 0.018]时的活动VAS评分FNB组低于QLB组。QLB未产生一致的皮肤感觉阻滞。
在当前研究条件下，接受THA的患者中，连续QLB的镇痛效果不如连续FNB。
