title: Randomised trial comparing the transversus abdominis plane block posterior approach or quadratus lumborum block type I with femoral block for postoperative analgesia in femoral neck fracture, both ultrasound-guided.
abstract: BACKGROUND
  A double-blind randomised controlled trial was conducted to compare the analgesic effect of the transversus abdominis plane block posterior approach or the quadratus lumborum block I versus femoral block, both ultrasound-guided.
  
  
  METHODS
  Prospective study with parallel groups with 104 patients with neck of femur fracture undergoing hemiarthroplasty (although 7 participants did not finish the study). The inclusion criteria were patients older than 65 years old, ASA I-III status, who required and gave their consent for hemiarthroplasty. The exclusion criteria were patients with known allergy to local anaesthetics, mental disability, peripheral neuropathy, a coagulopathy disorder, and those patients who received morphine, or a block was performed previous to the surgery. Each patient received one block followed by a spinal anaesthetic technique, performed by the anaesthetist. Pain was measured using a visual analogue score, sensory blockade using cold spray, and motor blockade, evaluating the leg movement. These were compared on arrival in recovery and at 6, 12, 18, and 24h later. Total opioid amount administered in 24 hours, duration of stay in post-anaesthesia care unit, patient satisfaction, and adverse effects were also recorded.
  
  
  RESULTS
  A lower visual analogue score was observed in the quadratus lumborum block group at 6, 12, 18 and 24h (3.7, 1.4, 0.8, 0.7 versus 5.2, 4.6, 3.4, 2.6 in the femoral group, P<.01). Opioid use in 24h was lower in this group (9.7 versus 16.9mg in the femoral group, P<.01). The sensory and motor blockade, satisfaction, and adverse effects, were similar in both groups.
  
  
  CONCLUSIONS
  Quadratus lumborum block is an effective analgesic option to be used in patients with neck of femur fracture. More clinical trials are required to validate this.
authors: St George's Hospital, NHS Trust Foundation, Londres, Reino Unido. Electronic address: tparrasmaldonado@gmail.com.
authors: T
authors: T
authors: Parras
authors: Corniche Hospital, Abu Dabi, Emiratos Árabes.
authors: R
authors: R
authors: Blanco
mesh_terms: D000009:Abdominal Muscles; D000698:Analgesia; D004311:Double-Blind Method; D005265:Femoral Neck Fractures; D006801:Humans; D009407:Nerve Block; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
keywords: Analgesia; Anestesia raquídea; Bloqueo nervioso; Clinical trial; Dolor; Ensayo clínico; Hemiarthroplasty; Hemiartroplastia; Nerve block; Pain; Spinal anaesthesia