RESUMO
BACKGROUND: Commonly used epidural or systemic analgesics for pain control after hip surgery carry risk for potential adverse effects. In contrast, the quadratus lumborum block (QLB) utilizes a simple and easy fascial plane technique and provides a wide area of sensory blockade. Thus, the QLB may be beneficial as analgesia after total hip arthroplasty. CASE: Here, we report the case of an 83-year-old man who received a continuous transmuscular QLB as part of a multimodal analgesia after hardware removal and total hip arthroplasty. The patient received a continuous infusion of 0.2% ropivacaine at 8 ml/h through an indwelling catheter in addition to patient-controlled analgesia with intravenous fentanyl and oral celecoxib. The patient's pain scores did not exceed 4, and no additional analgesics were required until postoperative day 5. CONCLUSIONS: Transmuscular QLB may be a suitable option for multimodal analgesia after total hip arthroplasty.
Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Artroplastia de Quadril/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Músculos Abdominais/diagnóstico por imagem , Idoso de 80 Anos ou mais , Analgesia Controlada pelo Paciente/métodos , Humanos , Masculino , Dor Pós-Operatória/etiologia , Ropivacaina/administração & dosagemRESUMO
BACKGROUND: The fascia iliaca compartment block (FICB) provides an analgesic effect in patients with femur fractures. However, the postoperative pain after hip surgery is different from that after femur fracture, because of the difference in the degree and location of tissue trauma. Whether FICB provides effective postoperative analgesia in patients undergoing total hip arthroplasty is not well understood. Moreover, there is no prospective randomized study to evaluate FICB as a postoperative analgesia in hemiarthroplasty. Therefore, we performed a randomized and prospective study to determine the effect of FICB after hemiarthroplasty. The objective of this study was to compare the opioid consumption between patients who received intravenous patient-controlled analgesia (PCA) with and without FICB. METHODS: Twenty-two patients aged 70 to 90 years who underwent bipolar hemiarthroplasty for femoral neck fracture were recruited and allocated randomly into 2 groups: FICB group (n = 11) and Non-FICB group (n = 11). All patients received spinal anesthesia with 10âmg of 0.5% hyperbaric bupivacaine. After surgery, the FICB was conducted using a modified technique with 0.2% ropivacaine (40âmL) under ultrasonographic guidance, and the intravenous PCA was administered to patients in both groups in the separate block room. The PCA was set up in the only bolus mode with no continuous infusion. The visual analog scale (VAS) and the opioid consumption were noted at 4, 8, 12, 24, and 48âhours postoperatively. RESULTS: The VAS was similar in both groups. The fentanyl requirement at 4, 8, and 12âhours was low in the FICB group. The total amount of fentanyl required in the first 24âhours was 246.3âµg in the FICB group and 351.4âµg in the Non-FICB group. No patient developed any residual sensory-motor deficit during the postoperative period. Patients in the Non-FICB group had nausea (n = 2), and pruritus (n = 1), and 1 patient had nausea in the FICB group during postoperative 2 days. CONCLUSION: The FICB has a significant opioid-sparing effect in first 24âhours after hemiarthroplasty. This suggests that FICB is an effective way for multimodal analgesia in hip surgery.