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Abstract
Background and Aims Effective postoperative analgesia is crucial for ensuring early mobilisation after revision hip arthroplasty1 and reduce complications2. In our hospital, from 2014–17, pain scores were moderate to severe, and the mean length of stay (LoS) was 23 days. PQLBI was introduced in 2017 to improve analgesia and reduce LoS.
Methods Audit data for 2018–21 were reviewed retrospectively comparing patients having PQLBI with those who did not, for quality of analgesia, time to weight bearing, LoS and general complications . Data were collected using Lorenzo (DXC, Virginia) and e-Obs software (Alcidion, Australia). There were 49 patients. All received spinal anaesthesia (0.5% heavy bupivacaine, no opioid) and general anaesthesia. After surgery, 35/49 patients had PQLBI using 20 ml of 0.125% levobupivacaine injected in the fascial plane between quadratus lumborum and psoas muscles using a SonoSite C11E probe with in-plane approach, followed by an infusion via a Pajunk Echogenic catheter over-needle system, and delivered with a Baxter Elastometric pump with 300 mls 0.125% levobupivacaine for 72 hrs at 5–8 mls/hr.
Results Between 2018–2021, comparing PQLBI vs non-PQLBI, Verbal Rating Pain Scores (mean) were 1.03 vs 2.24, time to weight-bearing 1.15 days vs 4.55 days, and Los 5.15 days vs 10.33 days respectively. There were no complications in the PQLBI group, but delirium and pneumonia in 6/14 patients in the non-PQBLI group.
Conclusions PQLBI should be considered in revision hip surgery. There is reduced morphine consumption with low pain scores, facilitated early weight bearing and reduced LoS from 23 days to 5.15 (mean) days.