Single puncture combined lumbar erector spinae plane and quadratus lumborum block (SEQ block) in acetabular fracture surgeries: randomized clinical trial

Abstract

Background: Acetabular fracture surgery can cause severe postoperative pain. A combined lumbar erector spinae plane block (ESPB) and paraspinous sagittal shift (PSSS) quadratus lumborum (QL) block may augment intra and postoperative analgesia.Methods: Patients undergoing posterior column acetabular surgery were divided into: Group (Single puncture combined lumbar Erector spinae and Quadratus lumborum block) SEQ , patients who received an ultrasound guided SEQ block before induction of general anesthesia; and Group morphine (MOR), those who received GA and postoperative analgesia in the form of morphine.Results: Fifty-two patients were divided were equally into MOR and SEQ groups. Their demographic characteristics were comparable. The heart rate and mean arterial blood pressure were significantly lower in the SEQ group than in the MOR group between 60 and 180 min intraoperatively (P < 0.001). Postoperative resting and dynamic visual analogue scale (VAS) scores in the SEQ group were significantly lower than those in the MOR group at all studied periods (P = 0.022–0.001), except at 20 and 24 h postoperatively. Fentanyl was required in all MOR group patients at a mean dose of 110.0  28.42 g while 18 patients required fentanyl in SEQ group at a mean dose of 60.55  25.54 g. Postoperative morphine consumption was significantly less in SEQ group (6.33  2.37 mg) than MOR group (17.0  2.55 mg). Postoperative nausea and vomiting were recorded in eight and four patients in MOR and SEQ group, respectively. No complications associated with the block technique were observed. Conclusions: The SEQ block reduces the postoperative opioid consumption and provides stable intra and postoperative hemodynamics without observed complications in posterior column acetabular surgery.