scholarly journals Ultrasound-Guided Anterior Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Related Side Effects in Patients Undergoing Total Hip Replacement Arthroplasty: A Propensity Score-Matched Cohort Study

2021 ◽  
Vol 10 (20) ◽  
pp. 4632
Author(s):  
Yeon-Ju Kim ◽  
Hyung-Tae Kim ◽  
Ha-Jung Kim ◽  
Pil-Whan Yoon ◽  
Ji-In Park ◽  
...  
Keyword(s):  
Side Effects ◽  
Propensity Score ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Opioid Consumption ◽  
Ultrasound Guided ◽  
Pain Scores ◽  
Quadratus Lumborum Block ◽  
Replacement Arthroplasty ◽  
Quadratus Lumborum

Quadratus lumborum block (QLB) has been shown to be effective for pain relief after hip surgery. This study evaluated the efficacy of ultrasound-guided anterior QLB in pain control after total replacement hip arthroplasty (TRHA). A total of 115 patients receiving anterior QLB were propensity score-matched with 115 patients who did not receive the block. The primary outcome was opioid consumption at 24, 24–48, and 48 postoperative hours. Secondary outcomes included pain scores at the post-anesthesia care unit (PACU), 8, 16, 24, 32, 40, and 48 h length of hospital stay, time to first ambulation, and the incidence of opioid-related side effects. Postoperative opioid consumption 48 h after surgery was significantly lower in the QLB group. Resting, mean, worst, and the difference of resting pain scores compared with preoperative values were significantly lower in the QLB group during the 48 postoperative hours. The length of hospital stay was shorter in the QLB group. The incidence of postoperative nausea and vomiting was significantly lower in the QLB group during the 48 postoperative hours, except at the PACU. This study suggests that anterior QLB provides effective postoperative analgesia for patients undergoing THRA performed using the posterolateral approach.

scholarly journals Postoperative analgesia and opioid use following hip arthroscopy with ultrasound-guided quadratus lumborum block: a randomized controlled double-blind trial

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092099
Author(s):  
Liangjing Yuan ◽  
Ye Zhang ◽  
Chengshi Xu ◽  
Anshi Wu
Keyword(s):  
General Anesthesia ◽  
Hip Arthroscopy ◽  
Opioid Consumption ◽  
Hip Surgery ◽  
Opioid Use ◽  
Ultrasound Guided ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Vas Scores ◽  
Time Point

Objective To investigate the postoperative analgesic effect of ultrasound-guided quadratus lumborum block (QLB) in patients undergoing arthroscopic hip surgery. Methods Patients who were scheduled to undergo elective arthroscopic hip surgery were randomly assigned to the QLB (Q) or control (C) group (n = 40 each). After general anesthesia induction, unilateral QLB was performed under ultrasound guidance in the Q group. The amount of opioid use via patient-controlled analgesia (PCA) and the resting and movement pain visual analog scale (VAS) scores when the patient left the postanesthesia care unit (PACU) and 4, 8, 12, and 24 hours after surgery were recorded. Postoperative complications were recorded for both groups. Results At 24 hours post-surgery, opioid consumption amounts via PCA (48.4 [48.1–48.6] mL) in the Q group were significantly lower compared with the C group (52.0 [51.0–53.8] mL). A significant reduction in opioid consumption was observed between the two groups at each time point. Resting and movement VAS scores at each time point were significantly lower in the Q compared with the C group. Conclusions Hip arthroscopy patients who received QLB and general anesthesia in combination had less pain and a lower opioid requirement within 24 hours postoperatively.

scholarly journals Ultrasound-Guided Quadratus Lumborum Block as A Postoperative Analgesia for Total Abdominal Hysterectomy: A Case Report

2021 ◽  
Author(s):  
Haytham El Sayed Mohamed ◽  
Fadheela Al Najar ◽  
Mohamed Nasr Awad ◽  
Faten M Hassan
Keyword(s):  
Side Effects ◽  
Abdominal Surgery ◽  
Analgesic Effect ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Multimodal Analgesia ◽  
Ultrasound Guided ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Obstructive Sleep

Abstract Background and aim: Total Abdominal Hysterectomy is a major invasive abdominal surgery which is accompanied with severe postoperative pain. Multimodal analgesia techniques can provide efficient analgesics coverage with minimal side effects, Quadratus Lumborum Block is an abdominal wall block which gives a good analgesic effect for abdominal surgery with lower pain score and less opioids requirements.Case presentation: A 67 years old female was scheduled to undergo total abdominal hysterectomy surgery, she had comorbidities; morbid obesity, bronchial asthma, obstructive sleep apnea, and hypothyroidism. We performed General Anesthesia and by the end of surgery, a Quadratus Lumborum Block was done ultrasound-guided technique.Conclusion: We successfully performed Quadratus Lumborum Block bilaterally which was able to provide a sufficient analgesic effect for Total Abdominal Hysterectomy surgery, giving our patient the opportunity of early ambulation and avoiding opioids side effects especially the respiratory adverse effect.

Implementation of a Standardized Multimodal Postoperative Analgesia Protocol Improves Pain Control, Reduces Opioid Consumption, and Shortens Length of Hospital Stay After Posterior Lumbar Spinal Fusion

Neurosurgery ◽  
2019 ◽  
Vol 87 (1) ◽  
pp. 130-136 ◽  
Author(s):  
Corey T Walker ◽  
David M Gullotti ◽  
Virginia Prendergast ◽  
John Radosevich ◽  
Doneen Grimm ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Spinal Fusion ◽  
Pain Control ◽  
Length Of Hospital Stay ◽  
Multimodal Analgesia ◽  
Opioid Consumption ◽  
Evidence Based ◽  
Lumbar Spinal Fusion ◽  
Pain Scores ◽  
Lumbar Spinal

Abstract BACKGROUND Multimodal analgesia regimens have been suggested to improve pain control and reduce opioid consumption after surgery. OBJECTIVE To institutionally implement an evidence-based quality improvement initiative to standardize and optimize pain treatment following neurosurgical procedures. Our goal was to objectively evaluate efficacy of this multimodal protocol. METHODS A retrospective cohort analysis of pain-related outcomes after posterior lumbar fusion procedures was performed. We compared patients treated in the 6 mo preceding (PRE) and 6 mo following (POST) protocol execution. RESULTS A total of 102 PRE and 118 POST patients were included. The cohorts were well-matched regarding sex, age, surgical duration, number of segments fused, preoperative opioid consumption, and baseline physical status (all P > .05). Average patient-reported numerical rating scale pain scores significantly improved in the first 24 hr postoperatively (5.6 vs 4.5, P < .001) and 24 to 72 hr postoperatively (4.7 vs 3.4, P < .001), PRE vs POST, respectively. Maximum pain scores and time to achieving appropriate pain control also significantly improved during these same intervals (all P < .05). A concomitant decrease in opioid consumption during the first 72 hr was seen (110 vs 71 morphine milligram equivalents, P = .02). There was an observed reduction in opioid-related adverse events per patient (1.31 vs 0.83, P < .001) and hospital length of stay (4.6 vs 3.9 days, P = .03) after implementation of the protocol. CONCLUSION Implementation of an evidence-based, multimodal analgesia protocol improved postoperative outcomes, including pain scores, opioid consumption, and length of hospital stay, after posterior lumbar spinal fusion.

Impact of ultrasound-guided erector spinae plane block on outcomes after lumbar spinal fusion: a retrospective propensity score matched study of 242 patients

2021 ◽  
pp. rapm-2021-103199
Author(s):  
Ellen M Soffin ◽  
Ichiro Okano ◽  
Lisa Oezel ◽  
Artine Arzani ◽  
Andrew A Sama ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Care Pathway ◽  
Lumbar Fusion ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Block Group ◽  
Ultrasound Guided ◽  
Erector Spinae Plane Block ◽  
Pain Scores

BackgroundWe evaluated the impact of bilateral ultrasound-guided erector spinae plane blocks on pain and opioid-related outcomes within a standardized care pathway for lumbar fusion.MethodsA retrospective propensity score matched cohort study. Clinical data were extracted from the electronic medical records of patients who underwent lumbar fusion (January 2019–July 2020). Propensity score matching based on common confounders was used to match patients who received or did not receive blocks in a 1:1 ratio. Primary outcomes were Numeric Rating Scale pain scores (0–10) and opioid consumption (morphine equivalent dose) in the first 24 hours after surgery (median (IQR)). Secondary outcomes included length of stay and opioid-related side effects.ResultsOf 1846 patients identified, 242 were matched and analyzed. Total 24-hour opioid consumption was significantly lower in the erector spinae plane block group (30 mg (0, 144); without-blocks: 45 mg (0, 225); p=0.03). There were no significant differences in pain scores in the postanesthesia care unit (with blocks: 4 (0, 9); without blocks: 4 (0,8); p=0.984) or on the nursing floor (with blocks: 4 (0,8); without blocks: 4 (0,8); p=0.134). Total length of stay was 5 hours shorter in the block group (76 hours (21, 411); without blocks: 81 (25, 268); p=0.001). Fewer patients who received blocks required postoperative antiemetic administration (with blocks: n=77 (64%); without blocks: n=97 (80%); p=0.006).ConclusionsErector spinae plane blocks were associated with clinically irrelevant reductions in 24-hour opioid consumption and no improvement in pain scores after lumbar fusion. The routine use of these blocks in the setting of a comprehensive care pathway for lumbar fusion may not be warranted.

P145 OPTIMAL PERIOPERATIVE PAIN MANAGEMENT IN ESOPHAGEAL SURGERY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
ten Hoope M L Feenstra ◽  
W Hermanides ◽  
J Gisbertz ◽  
S S Hollmann ◽  
M W van Berge Henegouwen ◽  
...  
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Epidural Analgesia ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Fluid Administration ◽  
Opioid Consumption ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Perioperative Pain Management

Abstract Aim To compare paravertebral analgesia with epidural analgesia in thoracolaparoscopic Ivor Lewis esophagectomy. Background In esophagectomy, thoracic epidural analgesia (TEA) is standard of care for perioperative pain management. Although TEA is effective, it has unwanted side-effects, such as hypotension, urinary retention and epidural haematoma. Thoracoscopic guided paravertebral analgesia (PVA) is an alternative that is being applied more in thoracic surgery and supposedly has less side-effects. Methods In this feasibility study, TEA was compared with PVA for efficacy in two consecutive series of 25 thoracolaparoscopic Ivor Lewis esophagectomies. In PVA the catheter was placed by the surgeon under direct thoracoscopic vision. TEA consisted of continuous bupivacaine and sufentanil with a patient-controlled bolus function. PVA consisted of continuous bupivacaine and intravenous morphine patient-controlled analgesia. Primary outcome was the highest recorded Numeric pain Rating Scale (NRS) every 8 hours. Secondary outcomes included opioid consumption, vasopressor consumption, fluid administration and length of hospital stay. Results In both groups, the NRS was acceptable (below 5) during the first three postoperative days with no difference in overall pain. Patients with PVA had a higher NRS the first postoperative night (median 4 vs 0, p<0.001). Opioid consumption was significantly lower in patients with PVA. In TEA three catheters failed after successful insertion, in PVA only two. There was no difference in vasopressor consumption, fluid administration and length of hospital stay. Conclusion PVA seems to be a safe and effective alternative for TEA in thoracolaparoscopic Ivor Lewis esophagectomy. This hypothesis should be confirmed in a randomized trial.

scholarly journals Ultrasound-Guided Quadratus Lumborum Block as A Postoperative Analgesia for Total Abdominal Hysterectomy: A Case Report

2021 ◽  
Author(s):  
Haytham El Sayed Mohamed
Keyword(s):  
Side Effects ◽  
Abdominal Surgery ◽  
Analgesic Effect ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Multimodal Analgesia ◽  
Ultrasound Guided ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Obstructive Sleep

Abstract Background and aim: Total Abdominal Hysterectomy is a major invasive abdominal surgery which is accompanied with severe postoperative pain. Multimodal analgesia techniques can provide efficient analgesics coverage with minimal side effects, Quadratus Lumborum Block is an abdominal wall block which gives a good analgesic effect for abdominal surgery with lower pain score and less opioids requirements. Case presentation: A 67 years old female was scheduled to undergo total abdominal hysterectomy surgery, she had comorbidities; morbid obesity, bronchial asthma, obstructive sleep apnea, and hypothyroidism. We performed General Anesthesia and by the end of surgery, a Quadratus Lumborum Block was done ultrasound-guided technique. Conclusion: We successfully performed Quadratus Lumborum Block bilaterally which was able to provide a sufficient analgesic effect for Total Abdominal Hysterectomy surgery, giving our patient the opportunity of early ambulation and avoiding opioids side effects especially the respiratory adverse effect.

scholarly journals Multimodal Analgesia (MMA) Versus Patient-Controlled Analgesia (PCA) for One or Two-Level Posterior Lumbar Fusion Surgery

2020 ◽  
Vol 9 (4) ◽  
pp. 1087
Author(s):  
Sung-Woo Choi ◽  
Hyeung-Kyu Cho ◽  
Suyeon Park ◽  
Jae Hwa Yoo ◽  
Jae Chul Lee ◽  
...  
Keyword(s):  
Side Effects ◽  
Hospital Stay ◽  
Pain Score ◽  
Pain Control ◽  
Lumbar Fusion ◽  
Length Of Hospital Stay ◽  
Multimodal Analgesia ◽  
Opioid Consumption ◽  
Patient Controlled Analgesia ◽  
Posterior Lumbar Fusion

A multimodal analgesic method was known to avoid the high-dose requirements and dose-dependent adverse events of opioids, and to achieve synergistic effects. The purpose of this study was to compare the efficacy of our multimodal analgesia (MMA) regimen with that of the patient-controlled analgesia (PCA) method for acute postoperative pain management. Patients who underwent one or two-level posterior lumbar fusion (PLF) followed by either MMA or PCA administration at our hospital were compared for pain score, additional opioid and non-opioid consumption, side effects, length of hospital stay, cost of pain control, and patient satisfaction. From 2016 through 2017, a total 146 of patients were screened. After propensity score matching, 66 remained in the PCA and 34 in the MMA group. Compared with the PCA group, the MMA group had a shorter length of hospital stay (median (interquartile range): 7 days (5–8) vs. 8 (7–11); P = 0.001) and lower cost of pain control (70.6 ± 0.9 USD vs. 173.4 ± 3.3, P < 0.001). Baseline data, clinical characteristics, pain score, additional non-opioid consumption, side effects, and patient subjective satisfaction score were similar between the two groups. The MMA seems to be a good alternative to the PCA after one or two-level PLF.

Ultrasound-guided transmuscular quadratus lumborum block for elective cesarean section significantly reduces postoperative opioid consumption and prolongs time to first opioid request: a double-blind randomized trial

2019 ◽  
Vol 44 (9) ◽  
pp. 896-900 ◽  
Author(s):  
Christian K Hansen ◽  
Mette Dam ◽  
Gudny E Steingrimsdottir ◽  
Gunnar Hellmund Laier ◽  
Morten Lebech ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Cesarean Section ◽  
Opioid Consumption ◽  
Elective Cesarean Section ◽  
Ultrasound Guided ◽  
Double Blind ◽  
Pain Scores ◽  
Quadratus Lumborum ◽  
Opioid Administration ◽  
Elective Cesarean

BackgroundElective cesarean section (ECS) can cause moderate to severe pain that often requires opioid administration. To enhance maternal recovery, and promote mother and baby interaction, it is important to reduce postoperative pain and opioid consumption. Various regional anesthesia techniques have been implemented to improve postoperative pain management following ECS. This study aimed to investigate the efficacy of bilateral ultrasound-guided transmuscular quadratus lumborum (TQL) block on reducing postoperative opioid consumption following ECS.MethodsA randomized double-blind trial with concealed allocation was conducted in 72 parturients who received bilateral TQL block with either 30 mL ropivacaine 0.375% or saline. TQL block injectate was deposited in the interfascial plane between the quadratus lumborum and psoas major muscles, posterior to the transversalis fascia. Primary outcome was opioid consumption, which was recorded electronically. Pain scores and time to first opioid request were also evaluated.ResultsOpioid consumption (oral morphine equivalents, OME) was significantly reduced in group ropivacaine (GRO) in the first 24 hours compared with group saline (65 mg OME vs 94 mg OME) with a mean difference of 29 mg OME; 95% CI 3 to 55, p<0.03. Time to first opioid request was significantly prolonged in GRO, p<0.003. Numerical rating scale pain scores were significantly lower in GRO in the first 6 hours after surgery, p<0.03.ConclusionsBilateral TQL block significantly reduced 24 hours’ opioid consumption. Further, we observed significant prolongation in time to first opioid, and significant reduction of pain during the first 6 postoperative hours.

scholarly journals EFFICACY OF QUADRATUS LUMBORUM BLOCKS IN ROBOTIC NEPHRECTOMY- A RETROSPECTIVE REVIEW.

2021 ◽  
Author(s):  
Poonam Pai B.H ◽  
Yan H. Lai ◽  
Abimbola Onayemi ◽  
Hung-Mo Lin
Keyword(s):  
Enhanced Recovery ◽  
Opioid Consumption ◽  
Laparoscopic Nephrectomy ◽  
Control Group ◽  
Pain Scores ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Significant Difference ◽  
Enhanced Recovery Pathways ◽  
Recovery Pathways

Abstract Abstract: With the implementation of enhanced recovery pathways (ERAS) in kidney surgeries, regional techniques are being considered an important aspect of multimodal analgesia. Abdominal blocks such as quadratus lumborum block (QLB) have been used as an effective analgesic in abdominal surgeries, however their efficacy in kidney surgery remains unknown. To our best knowledge, there are no clinical studies exploring the relationship between QLBs and post-operative opioid consumption in robotic laparoscopic nephrectomy. Study Objectives: Assess analgesic efficacy between QLB and post-operative opioid consumption in robotic laparoscopic nephrectomy. Design and Setting: A retrospective chart review was conducted by querying the electronic medical record system of 2,200 bed tertiary academic hospital center in New York City. Outcomes: The primary measured outcome was postoperative morphine milli equivalent (MME) consumption for the first 24 hours. Secondary outcomes include intra-operative MME, as well as postoperative pain scores measured on a visual analogue scale (VAS) scale at 2, 6, 12, 18, and 24 hours post-operatively. Results: The mean total post-operative MME in the pQLB group was 11 [4, 18] and 15 [5.6, 28] in the control group (p =.001). There was a significant reduction in intra-operative MME in the QLB group in comparison to the control group. This reduction was not seen in post-operative MME. There was no significant difference in pain scores at any of the measured time points up to 24 hours post-operatively. Conclusion: Our study provides compelling support that ultrasound guided QLB significantly decreased intra operative opioid requirements but did not have the same effect on postoperative opioid requirements following robotic kidney surgeries in the context of an ERAS pathway. Keywords: Kidney surgeries, Robotic laparoscopic nephrectomy, quadratus lumborum block (QLB), enhanced recovery pathways (ERAS)

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