scholarly journals Ultrasound-Guided Transmuscular Quadratus Lumborum Block Reduces Postoperative Pain Intensity in Patients Undergoing Total Hip Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Jian He ◽  
Lei Zhang ◽  
Wan You He ◽  
Dong Lin Li ◽  
Xue Qin Zheng ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Pain Intensity ◽  
Hip Arthroplasty ◽  
Walking Speed ◽  
Controlled Study ◽  
Management Technique ◽  
Ultrasound Guided ◽  
Total Hip

Background and Objectives. Pain management following total hip arthroplasty (THA) has been widely investigated; however, the best effective method is yet to be determined. The aim of this prospective, placebo-controlled study was to evaluate the analgesic efficacy of ultrasound-guided QL3 block in patients undergoing THA. Methods. Eighty-eight patients undergoing THA were randomized to receive 0.33% ropivacaine (Group QLB, n = 44) or saline (Group Con, n = 44) for QL3 block. Spinal anesthesia was then performed. Pain intensity was assessed using the visual analog scale (0: no pain to 10: worst possible pain). The primary outcome was pain scores recorded at rest at 3, 6, 12, 24, 36, and 48 h and on standing and walking at 24, 36, and 48 h postoperatively. Secondary outcomes were analgesic consumption, side effects, the 10-meter walking speed on day 6, and patient satisfaction after surgery. Results. Postoperative pain intensity was significantly lower in Group QLB compared to Group Con at rest after 3, 6, 12, 24, 36, and 48 h (p<0.001) and during mobilization after 24, 36, and 48 h (p<0.001). Morphine use was significantly lower in Group QLB compared to Group Con during 0–24 h (16.0 ± 7.1 vs. 34.1 ± 7.1 mg, p<0.001) and during 24–48 h (13.0 ± 4.0 vs. 17.4 ± 4.6 mg, p<0.001) postoperatively. The 10-meter walking speed was higher in Group QLB compared to Group Con, both at comfortable (0.79 ± 0.13 vs. 0.70 ± 0.14 m/s, p=0.012) and at maximum speeds (1.18 ± 0.26 vs. 1.06 ± 0.22 m/s, p<0.001). Incidences of nausea (7.3% vs. 31%, p=0.006), vomiting (7.3% vs. 26.2%, p = 0.022), and urinary retention (9.8% vs. 28.6%, p=0.030) were lower in Group QLB than in Group Con. Conclusions. Ultrasound-guided QL3 block is an effective pain management technique after THA.

Pain intensity in total hip arthroplasty patients: how communication influences satisfaction

2019 ◽  
Vol 30 (6) ◽  
pp. 690-694 ◽  
Author(s):  
Nequesha S Mohamed ◽  
Iciar M Dávila Castrodad ◽  
Chukwuweike U Gwam ◽  
Jennifer I Etcheson ◽  
Alexandra N Passarello ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Total Hip Arthroplasty ◽  
Pain Intensity ◽  
Hip Arthroplasty ◽  
Health Care Quality ◽  
Care Quality ◽  
Total Hip ◽  
Management Domain ◽  
Survey Responses

Introduction: An important global measure of health care quality is patient satisfaction. Patient satisfaction partially determines hospital reimbursement for procedures such as total hip arthroplasty (THA). Press Ganey (PG) survey responses assess patient satisfaction, and impact reimbursement. Current efforts to maximise repayment for THA include reducing postoperative pain. The “Pain Management” survey domain is considered a significant factor in patient ratings, but other studies have highlighted staff communication domains as determinants of satisfaction. Therefore, the purpose of this study is to compare PG survey responses to inpatient pain intensity. Methods: We queried the PG database for all patients who underwent a THA between November 2012 and January 2015. This yielded a total of 302 patients. Descriptive statistics were performed to analyse patient-level demographics. A multivariate regression model was constructed utilising pain intensity as the dependent variable. Results: Patients rating of “Communication with Doctors” ( B = –25.534; p < 0.001) and “Communication about Medicines” ( B = –31.49; p = < 0.001) domains were representative of patient pain intensity. No other factors demonstrated a significant relationship to pain intensity. Conclusions: Patient satisfaction continues to be important in care quality. Surrogate markers, such as the PG survey, can guide institutions looking to improve care. Our study revealed scores for “Communication with Doctors” and “Communication about Medicines” best represented true pain intensity levels for THA recipients during the postoperative period. The “Pain Management” domain did not display a relationship to pain intensity. The current method of measuring patient satisfaction should be reassessed to better represent patient responses and outcomes.

scholarly journals Postoperative Pain Treatment with Transmuscular Quadratus Lumborum Block and Fascia Iliaca Compartment Block in Patients Undergoing Total Hip Arthroplasty: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Qin Xia ◽  
Wenping Ding ◽  
Chao Lin ◽  
Jiayi Xia ◽  
Yahui Xu ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Elderly Patients ◽  
Hip Arthroplasty ◽  
Controlled Study ◽  
Total Hip ◽  
Randomized Controlled ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Fascia Iliaca Compartment Block

Abstract Background: Patients after total hip arthroplasty (THA) often suffered moderate or even severe pain, seriously affecting the early postoperative recovery. This study aimed to investigate the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block (T-QLB) combined with fascia iliaca compartment block (FICB) for elderly patients undergoing THA.Methods: Sixty-four patients scheduled for THA were included in this randomized controlled study. The patients were divided into two groups: group Q and group QF. Before anesthesia induction, group Q was injected with 0.375% ropivacaine 40ml. In the QF group, T-QLB combined with FICB was injected with 0.375% ropivacaine 20ml, respectively. Paracetamol 1g regularly at 6 h intervals and patient-controlled intravenous analgesia (PCIA) were administrated in both groups postoperatively. The primary outcome was cumulative sufentanil consumption via PCIA on postoperative 24 h. The secondary outcomes included pain degree, time to the first analgesic requirement, range of motion, quality of recovery, and the incidence of postoperative complications.Results: Compared with the group Q, the cumulative sufentanil consumption were significantly lower in group QF at 6-12, 12-18, 18-24, and 24h (49.29±16.76 vs. 31.42±18.81μg, P <0.001) after surgery. The postoperative pain intensity was lower in group QF at rest after 6, 12, and 24 h (P <0.05) and at activity after 6, 12, 18, and 24 h (P <0.05). Group QF had higher Qor-15 scores at postoperative 24 h and 48 h (P <0.001) and longer duration before the first opioid require via PCIA (P <0.001) postoperatively than group Q. There was no statistically significant difference between the two groups for complications postoperatively of elderly.Conclusions: Our study provides a multimodal, opioid-sparing analgesic regimen for elderly patients in THA. The combination of T-QLB and FICB provides a significant advantage for early postoperative functional recovery. Further studies are required to confirm the minimum effective dose.Trial registration: Chinese Clinical Trial Registry(ChiCTR2000038686).

scholarly journals Continuous pericapsular nerve group block for postoperative pain management in total hip arthroplasty: report of two cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Takashi Fujino ◽  
Masahiko Odo ◽  
Hisako Okada ◽  
Shinji Takahashi ◽  
Toshihiro Kikuchi
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Rating Scale ◽  
Femoral Nerve Block ◽  
Numerical Rating Scale ◽  
Femoral Nerve ◽  
Postoperative Pain Management ◽  
Total Hip

Abstract Background Total hip arthroplasty (THA) is one of the surgical procedures associated with severe postoperative pain. Appropriate postoperative pain management is effective for promoting early ambulation and reducing the length of hospital stay. Effects of conventional pain management strategies, such as femoral nerve block and fascia iliaca block, are inadequate in some cases. Case presentation THA was planned for 2 patients with osteoarthritis. In addition to general anesthesia, continuous pericapsular nerve group (PENG) block and lateral femoral cutaneous nerve (LFCN) block were performed for postoperative pain management. Numerical rating scale (NRS) scores measured at rest and upon movement were low at 2, 12, 24, and 48 h postoperatively, suggesting that the treatments were effective for managing postoperative pain. The Bromage score at postoperative days (POD) 1 and 2 was 0. Conclusion Continuous PENG block and LFCN block were effective for postoperative pain management in patients who underwent THA. PENG block did not cause postoperative motor blockade.

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