المؤلفون: Hummel A; John A Burns School of Medicine., University of Hawai'I, 651 Ilalo Street, Honolulu, HI, 96813, USA., Gaucher D; Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA., Wang P; Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA., Lawton DRY; John A Burns School of Medicine., University of Hawai'I, 651 Ilalo Street, Honolulu, HI, 96813, USA., Andrews SN; Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA.; Department of Kinesiology and Rehabilitation Science, University of Hawai'I, 1337 Lower Campus Road, Honolulu, HI, 96822, USA., Nakasone CK; Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA. onohunter@icloud.com.; Department of Surgery, John A Burns School of Medicine, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA. onohunter@icloud.com.

المصدر: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2023 Nov; Vol. 143 (11), pp. 6849-6855. Date of Electronic Publication: 2023 Jun 03.

نوع المنشور: Randomized Controlled Trial; Journal Article

بيانات الدورية: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9011043 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1434-3916 (Electronic) Linking ISSN: 09368051 NLM ISO Abbreviation: Arch Orthop Trauma Surg Subsets: MEDLINE

مواضيع طبية MeSH: Arthroplasty, Replacement, Hip*/adverse effects , Nerve Block*/methods, Humans ; Narcotics ; Follow-Up Studies ; Prospective Studies ; Pain, Postoperative/drug therapy ; Pain, Postoperative/etiology ; Analgesics, Opioid/therapeutic use ; Anesthetics, Local

مستخلص: Background: This was a prospective single-blinded study comparing the peri-operative opioid consumption and motor weakness for patients undergoing total hip arthroplasty (THA) with either a Quadratus Lumborum Type 3 Nerve Block (QLB) or a Paravertebral Nerve Block (PVB).
Methods: A consecutive cohort of patients undergoing elective anterior approach (AA) THA by a single high-volume surgeon were randomly assigned an anesthesiologist by the charge anesthesiologist. One anesthesiologist performed all QLBs, and the other six anesthesiologists performed the PVBs. Pertinent data include prospectively collected qualitative surveys from blinded medical personnel, floor nurses, and physical therapists as well as demographic information and post-operative complications.
Results: Overall, 160 patients were included in the study divided equally between the QLB and PVB groups. The QLB group had a statistically higher peri-operative narcotic use (p < 0.001), greater intra-operative peak systolic blood pressure (p < 0.001) and respiratory rate (p < 0.001), and higher incidence of post-operative lower extremity muscle weakness (p = 0.040). There were no statistical group differences for floor narcotic use, post-operative hemoglobin levels or hospital length of stay.
Conclusion: The QLB required greater intraoperative narcotic use and resulted in greater post-operative weakness, however provided nearly equal post-operative pain management and did not adversely affect rapid discharge success.
Level of Evidence: III, Non-randomized controlled cohort/follow-up study.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)