Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, No.99, Huaihai West Road, Quanshan District, Jiangsu Province, 221000, China.
Department of Anesthesiology, Xuzhou Central Hospital, 199 Jiefang South Road, Quanshan District, Jiangsu Province, 221000, China.
BMC Anesthesiol. 2021 Jul 10;21(1):188. doi: 10.1186/s12871-021-01413-7.
Patients often suffer moderate or even severe pain after total hip arthroplasty; such pain seriously affects early postoperative recovery. This study aimed to investigate the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block combined with fascia iliaca compartment block for elderly patients undergoing total hip arthroplasty.
Fifty-four patients scheduled for total hip arthroplasty were included in this randomized controlled study. The patients were randomly assigned to receive only transmuscular quadratus lumborum block (group Q) or transmuscular quadratus lumborum block combined with fascia iliaca compartment block (group QF) with ultrasound guidance. Postoperatively in both groups, paracetamol 1 g was regularly administered at 6 h intervals and patient-controlled intravenous analgesia was administered. The primary outcome was cumulative sufentanil consumption via patient-controlled intravenous analgesia 24 h postoperatively. The secondary outcomes included pain degree, time to the first analgesic requirement, joint range of motion, quality of recovery, and the incidence of postoperative complications.
Fifty patients were included, and their data were analyzed. The cumulative sufentanil consumption in group QF was significantly lower during the first 24 h after surgery than that in group Q, and the cumulative sufentanil consumption in group QF was reduced at 6-12 and 12-18 h after surgery. The postoperative pain intensity was lower in group QF than in group Q (linear mixed-effects model, the main effect of treatment: P < 0.001). Compared with group Q, group QF had higher quality of recovery and joint range of movement. The time to the first analgesic requirement was longer in group QF than in group Q (log-rank, P < 0.001). There was no statistically significant difference in complications postoperatively between the two groups.
Our study provides a multimodal, opioid-sparing analgesic regimen for elderly patients undergoing total hip arthroplasty. The combination of transmuscular quadratus lumborum block and fascia iliaca compartment block provides a significant advantage for early postoperative functional recovery. Further studies are required to confirm the minimum effective dose.
The study was registered on the 21st December 2020 (retrospectively registered) on the Chinese Clinical Trial Registry: ChiCTR2000038686 .
全髋关节置换术后患者常遭受中至重度疼痛，严重影响术后早期康复。本研究旨在探讨超声引导下竖脊肌肌间沟阻滞联合髂筋膜间隙阻滞用于老年全髋关节置换术患者的镇痛效果。
本随机对照研究纳入了 54 例行全髋关节置换术的患者。患者被随机分为仅接受竖脊肌肌间沟阻滞（Q 组）或超声引导下竖脊肌肌间沟阻滞联合髂筋膜间隙阻滞（QF 组）。两组患者术后均每 6 小时给予 1 g 对乙酰氨基酚，并给予患者自控静脉镇痛。主要结局为术后 24 小时内患者自控静脉镇痛累积舒芬太尼消耗量。次要结局包括疼痛程度、首次需要镇痛的时间、关节活动度、恢复质量和术后并发症发生率。
纳入 50 例患者，对其数据进行分析。与 Q 组相比，QF 组术后 24 小时内患者自控静脉镇痛累积舒芬太尼消耗量显著降低，且在术后 6-12 小时和 12-18 小时时，QF 组的舒芬太尼消耗量降低。与 Q 组相比，QF 组术后疼痛强度更低（线性混合效应模型，治疗的主要效应：P<0.001）。与 Q 组相比，QF 组恢复质量和关节活动度更高。与 Q 组相比，QF 组首次需要镇痛的时间更长（对数秩检验，P<0.001）。两组术后并发症发生率无统计学差异。
本研究为老年全髋关节置换术患者提供了一种多模式、阿片类药物节约型镇痛方案。竖脊肌肌间沟阻滞联合髂筋膜间隙阻滞为早期术后功能恢复提供了显著优势。需要进一步研究来确定最小有效剂量。
本研究于 2020 年 12 月 21 日在中国临床试验注册中心注册（回顾性注册），注册号为 ChiCTR2000038686。
