全髋关节置换术中腰方肌后支阻滞：一项随机对照试验

Posterior Quadratus Lumborum Block in Total Hip Arthroplasty: A Randomized Controlled Trial.

作者信息

Brixel Sophia Margareta, Biboulet Philippe, Swisser Fabien, Choquet Olivier, Aarab Yassir, Nguyen Helen, Bringuier Sophie, Capdevila Xavier

出版信息

Anesthesiology. 2021 May 1;134(5):722-733. doi: 10.1097/ALN.0000000000003745.

DOI:10.1097/ALN.0000000000003745

PMID:33740816

Abstract

BACKGROUND

Pain management is important for ensuring early mobilization after hip arthroplasty; however, the optimal components remain controversial. Recently, the quadratus lumborum block has been proposed as an analgesic option. The current study tested the hypothesis that the posterior quadratus lumborum block combined with multimodal analgesia decreases morphine consumption after hip arthroplasty.

METHODS

This study was a prospective, randomized, double-blind, placebo-controlled trial. Before general anesthesia, 100 participating patients scheduled for elective total hip arthroplasty were randomly allocated to receive a 30-ml injection posterior to the quadratus lumborum muscle with either 0.33% ropivacaine (n = 50) or normal saline (n = 50). For all patients, multimodal analgesia included systematic administration of acetaminophen, ketoprofen, and a morphine intravenous patient-controlled analgesia. The primary outcome was total intravenous morphine consumption in the first 24 h. Secondary outcomes recorded intraoperative sufentanil consumption; morphine consumption in the postanesthesia care unit; pain scores at extubation and at 2, 6, 12, and 24 h; motor blockade; time to first standing and ambulation; hospital length of stay; and adverse events.

RESULTS

There was no significant difference in the 24-h total morphine consumption (ropivacaine group, median [interquartile range], 13 [7 to 21] versus saline group, 16 [9 to 21] mg; median difference, -1.5; 95% CI, -5 to 2; P = 0.337). Pain scores were not different between the groups (β = -0.4; 95% CI, -0.9 to 0.2; P = 0.199). There was no statistical difference between the two groups in intraoperative sufentanil consumption, morphine consumption in the postanesthesia care unit, motor blockade, times to first standing (median difference, 0.83 h; 95% CI, -1.7 to 3.4; P = 0.690) and ambulation (median difference, -1.85 h; 95% CI, -4.5 to 0.8; P = 0.173), hospital length of stay, and adverse events.

CONCLUSIONS

After elective hip arthroplasty, neither morphine consumption nor pain scores were reduced by the addition of a posterior quadratus lumborum block to a multimodal analgesia regimen.

摘要

背景

疼痛管理对于确保髋关节置换术后早期活动很重要；然而，最佳组成部分仍存在争议。最近，腰方肌阻滞已被提议作为一种镇痛选择。本研究检验了以下假设：腰方肌后阻滞联合多模式镇痛可减少髋关节置换术后吗啡的用量。

方法

本研究为前瞻性、随机、双盲、安慰剂对照试验。在全身麻醉前，将100例计划行择期全髋关节置换术的参与研究患者随机分为两组，分别接受在腰方肌后方注射30 ml的0.33%罗哌卡因（n = 50）或生理盐水（n = 50）。对于所有患者，多模式镇痛包括系统给予对乙酰氨基酚、酮洛芬和吗啡静脉自控镇痛。主要结局是术后24小时内静脉注射吗啡的总用量。次要结局包括术中舒芬太尼用量；麻醉后恢复室的吗啡用量；拔管时以及术后2、6、12和24小时的疼痛评分；运动阻滞；首次站立和行走的时间；住院时间；以及不良事件。

结果

两组术后24小时吗啡总用量无显著差异（罗哌卡因组，中位数[四分位间距]，13[7至21]mg，而生理盐水组为16[9至21]mg；中位数差异为-1.5；95%CI为-5至2；P = 0.337）。两组间疼痛评分无差异（β = -0.4；95%CI为-0.9至0.2；P = 0.199）。两组在术中舒芬太尼用量、麻醉后恢复室的吗啡用量、运动阻滞、首次站立时间（中位数差异为0.83小时；95%CI为-1.7至3.4；P = 0.690）和行走时间（中位数差异为-1.85小时；95%CI为-4.5至0.8；P = 0.173）、住院时间和不良事件方面均无统计学差异。