Comparative study between three approaches of ultrasound guided quadratus lumborum block for post-operative analgesia in total hip replacement with spinal anaesthesia

Background: Early postoperative ambulation and reduction of hospital stay necessitate efficient postoperative analgesia.Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery.Objective: compare between different approaches of ultrasound guided quadratus lumborum block for post-operative analgesia in total hip replacement with spinal anaesthesia.Patients and Methods: This study was conducted in Orthopedic surgery operating unit in Al-Azhar University Hospitals (Al-Hussein and Sayed Galal), and approved by the ethics committee from the Department of Anesthesia of Faculty of Medicine, Al-Azhar University.Patients gave written informed consents.A total of 80 patients undergoing total hip replacement with spinal anesthesia were enrolled in our study.Eligible patients were randomly classified into four groups; 20 patients had received lateral QLB (QLB-1), 20 patients had received posterior QLB (QLB-2), 20 patients had received transmuscular QLB (QLB-3).QL blocks were done using 20 ml of Bupivacaine 0.25 %.The remaining 20 patients had received spinal anaesthesia only (SAB) that served as control group. Results:The time of requirement of first analgesia significantly prolonged in QLB-3 compared to QLB-1, QLB-2 and SAB control and prolonged in QLB-1 and QLB-2 than SAB control with insignificant differences between QLB1 and QLB-2.The total doses of rescue morphine were significantly lower in QLB-3 compared to QLB-1, QLB-2 and SAB control, and lower in QLB-1 and QLB-2 than SAB control with insignificant differences between QLB1 and QLB-2.VAS was significantly different among the four groups at 2, 12 and 24 hours (P <0.001) but was insignificantly different at PACU and 6 hours.VAS at 2 hours was significantly lower in QLB-3 compared to QLB-1, QLB-2 and SAB Control but with insignificant differences among QLB1, QLB-2 and SAB control group.VAS at 12 and 24 hours were significantly lower in QLB-3 compared to QLB-1, QLB-2 and SAB Control and lower in QLB-1 and QLB-2 than SAB Control with insignificant differences between QLB1 and QLB-2.e110 Comparative study between three approaches of ultrasound guided quadratus lumborum block for post-operative analgesia in total hip replacement with spinal anaesthesia