Efficacy and safety of combined lumbar plexus and quadratus lumborum block via Shamrock approach at L3 in total hip arthroplasty: a prospective randomized controlled trial.

研究概要

Eighty-four patients with conditions requiring elective unilateral total hip arthroplasty were randomized to receive lumbar plexus block at L3 (P group, n=28), T12 paravertebral block combined with lumbar plexus blocks at L3 and L4 (TP group, n=28), or lumbar plexus block combined with transmuscular quadratus lumborum block at L3 (PQ group, n=28). The primary outcome of interest was the effective rate of sensory block measured by the cutaneous sensory block area. Secondary outcomes included postoperative pain intensity, intraoperative sufentanil consumption, incidence of intraoperative hypotension, procedure time of the block, and complications related to the nerve block. Outcomes were assessed perioperatively and up to 24 hours postoperatively. Overall, the results of the study revealed that the combined LPB-TQLB technique demonstrated a substantially higher sensory block success rate and lower postoperative pain scores during movement compared with single-level LPB, while showing similar analgesic effectiveness to multi-level LPB. These findings suggest that the combined technique may provide effective analgesia with fewer technical challenges and a favorable safety profile for patients undergoing total hip arthroplasty.