Evaluation of Anterior Quadratus Lumborum Block for Postoperative Analgesia in Hip Arthroscopy

Phase 3

Completed

Brief Summary: Hip arthroscopy is performed frequently and the postoperative course often involves moderate to severe pain. There remains no definitive perioperative pain regimen that has been proven to be effective and safe for this ambulatory procedure. Some institutions perform peripheral nerve blocks either preoperatively or postoperatively as a rescue block. All of these PNBs lead to quadriceps weakness which may impede earlier mobilization and physical therapy. While some case reports exist, there have not been any studies evaluating the QLB for hip arthroscopy patients. As previously mentioned, the technique is easy to perform, well-tolerated by patients, and avoids side effects such as hypotension, urinary retention, or the quadriceps weakness associated with lumbar plexus blockade.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
QLB Block + Standard of Care	Ultrasound	Patients will receive either a spinal (4cc Mepivacaine) or combined spinal epidural anesthetic (dose up 50 5 cc 2% lidocaine) with IV sedation. Intraoperative anti-emetics will consist of IV ondansetron and IV dexamethasone. Intra-operative analgesics will be IV fentanyl, IV acetaminophen, IV ketorolac, and IV ketamine. No Block will be given. Patients will receive a single shot anterior QLB (30cc 0.5% Bupivacaine with 2mg preservative free dexamethasone).
QLB Block + Standard of Care	Bupivacaine + dexamethasone	Patients will receive either a spinal (4cc Mepivacaine) or combined spinal epidural anesthetic (dose up 50 5 cc 2% lidocaine) with IV sedation. Intraoperative anti-emetics will consist of IV ondansetron and IV dexamethasone. Intra-operative analgesics will be IV fentanyl, IV acetaminophen, IV ketorolac, and IV ketamine. No Block will be given. Patients will receive a single shot anterior QLB (30cc 0.5% Bupivacaine with 2mg preservative free dexamethasone).

Primary Outcome Measures

Name	Time	Method
Numerical Pain Rating System (NRS) Pain Scores	24 hours after Post Anesthesia Care Unite (PACU) arrival	Pain scores at rest and with movement will be through 24 hours after surgery. Score scale is from 0-10. 0 means no pain, 10 means worst pain. A lower score is a better outcome.

Secondary Outcome Measures

Name	Time	Method
Number of Patients With Presence of IAFE (Intraabdominal Fluid Extravasation) Following Surgery	Immediately post-op in OR
Incidence of Hypotension	Up to Post Op Day 1
Opioid Use	After Surgery to Post Operative Day 1	Amount of opioids taken after surgery
Antiemetic Use	Up to Post Op Day 1
Patient Satisfaction With Post Op Pain Control	Up to Post Op Day 1	Scale of 0-10; 0 being extremely dissatisfied and 10 being extremely satisfied
Change in Quadriceps Motor Strength on Surgical Side	Up to Post Op Day 1	Change in Quadriceps Motor Strength from Pre-Op Baseline Quadriceps Strength
Number of Participants With Hospital Admission	Up to Post Op Day 1
Urinary Retention	Up to Post Op Day 1	Incidence of Urinary Retention in recovery
Number of Patients With Nausea/Vomiting	Up to Post Op Day 1
Patient Score on Quality of Recovery-40 (QoR40) Inventory.	Up to Post Op Day 1	Validated QoR40 survey score. Survey questions are added up to provide a final score. Higher score is reflective of a better outcome. Minimum score is 40, maximum score is 200.