Quadratus Lumborum Block Reduces Postoperative Pain Scores and Opioids Consumption in Total Hip Arthroplasty: A Meta-Analysis.

Quadratus lumborum block (QL) is a relatively new regional anesthesia technique that has been used in different surgeries for improved outcomes. There are few case reports and studies about its role in total hip arthroplasty with variable effects. This study aimed to evaluate the effect of QL block on postoperative pain control, opioid consumption, and the incidence of postoperative adverse events in total hip arthroplasty surgeries. A systematic review of the scientific literature addressing the use of QL block in hip arthroplasty was performed following the PRISMA guidelines and using the online database databases, Medline and Science Direct. We registered this review with the PROSPERO database in May 2021 (reference number-CRD42021247055). Two authors performed the literature searches in June 2021 and repeated them in July 2021 to ensure accuracy. Review Manager software (RevMan for Mac, version 5.4; Cochrane Collaboration, Oxford, United Kingdom) was used to perform a meta-analysis of studies included in our review. Five randomized controlled trials were identified for inclusion (n=394) in our meta-analysis. The results demonstrated a beneficial effect of QL block in pain control at 6, 12, and 24 hours postoperatively after hip arthroplasty (p <0.05). Opioid consumption for 24 hours was significantly reduced in the QL group (p=0.010). Our study also demonstrated that QL block is associated with a significant reduction in postoperative nausea and vomiting (PONV) (p=0.04). In conclusion, QL block can provide significantly better pain control after total hip arthroplasty at 6, 12, and 24 hours postoperatively. It also results in significantly reduced 24 hour-opioid consumption. This block is also associated with a lesser incidence of PONV and a better satisfaction level postoperatively.

Intravenous ketamine in gynaecological surgeries reduces pain score and opioid consumption.

OBJECTIVE: To assess the effect of intravenous ketamine on postoperative pain control, opioid consumption, and the incidence of postoperative adverse events in gynaecological surgeries. METHODS: The systematic review and meta-analysis were conducted in July 2020 and the search was repeated in July 2021 to ensure accuracy. The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) as ID-CRD42020188637 in July 2020. The search, done on online databases Medline and Science Direct, comprised studies on patients who underwent general anaesthesia for gynaecological surgeries and received intravenous ketamine intraoperatively, and the findings included opioid consumption, postoperative pain control, and associated side-effects. RESULTS: Of the 79 randomised controlled trials found, 9 (11.4%) were subjected to meta-analysis. The use of intravenous ketamine reduced pain score at 2h (p=0.003) and 24h (p=0.002) postoperatively in gynaecological surgeries. In laparoscopic gynaecological surgeries, lower pain scores were reported at 1h (p=0.01) and 2h (p=0.002) postoperatively. Lower pain scores were reported at 24h postoperatively in open gynaecological surgeries (p=0.002). Intravenous ketamine increased the time to first-request analgesia postoperatively (p=0.03), and reduced postoperative 24h opioid consumption (p=0.002). CONCLUSIONS: The use of intravenous ketamine significantly reduced postoperative pain at 2h and 24h after gynaecological surgeries and at 1h and 2h after laparoscopic gynaecological surgeries.