Paraspinous Quadratus Lumborum Block: A New Analgesic Option for a Thigh Sarcoma Resection With Reconstruction-A Case Report.

Efficient pain management is essential for postoperative rehabilitation in patients undergoing a tumor resection with an immediate reconstructive surgery. Ultrasound-guided quadratus lumborum block has been described for abdominal or hip surgery, but not for concomitant surgery in the abdomen and the thigh. The paraspinous transmuscular approach has easy landmarks to perform this block. We present a case of a patient undergoing a resection of a sarcoma in the lower limb with an immediate reconstruction with a pedicled vertical designed deep inferior epigastric perforator flap, in whom a successful paraspinous transmuscular quadratus lumborum block for postoperative analgesia was performed.

COMBINED BLOCK OF THE FEMORAL AND LATERAL FEMORAL CUTANEOUS NERVES UNDER ULTRASOUND FOR POST- OPERATIVE ANALGESIA IN PATIENTS UNDERGOING HIP SURGERY: A DOUBLE BLIND RANDOMIZED TRIAL.

BACKGROUND: Inadequate pain management of post-operative pain of patients undergoing hip surgery can result in morbidity and mortality complications. Anatomically, pain resulted from the incision site innervation (Lateral femoral cutaneous nerve) and the hip joint innervation mainly the femoral nerve. Adding femoral nerve blockade to the multimodal regimen for postoperative pain control after hip surgery has been described. METHODS: all 31 patients included in the study received preoperatively combined FN and LFCN block with Normal Saline 0, 9% (group I) or bupivacaine 0.5% (group II) randomly by using a previously generated continuous randomization list kept in a closed envelope. Pain control regimen consisted of Perfalgan 1g IV every 6 hours systematically and Dolosal 50 mg IM every 6 hours if needed (i.e. VAS > 4). Pain level was measured by using Visual Analogue Scale (VAS) for the first 24 hours.Time to the first request of analgesia and the total dose of dolosal were calculated. RESULTS: The number of patients who requested narcotics was significantly higher in group I (8) than group II (3), P=0,044; the total dose of dolosal used was significantly higher in group 1 (50 mg) than group II (9,375mg), P=0,0058. Time to the first request for analgesia was significantly lower in group I (6hrs ± 5,12) as compared to Group II (21.3 hrs ± [Arabic letters: see text]), P =0,043. CONCLUSION: In conclusion, FN and LFCN block when added to the standard regimen for postoperative pain management after hip surgery had a benefit in decreasing pain scores as well as opioid consumption.