{
  "abstract": "Background and Aims Hip disarticulation and hemipelvectomy are radical amputations associated with severe postoperative pain and significant morbidity. Due to concerns regarding coagulopathy and vascular injury, neuraxial techniques or lumbar plexus blocks may be contraindicated. The anterior quadratus lumborum block (QLB), an interfascial block targeting T7-L2 dermatomes, presents a potential alternative for safe, effective analgesia.Methods We present four cases of patients undergoing hip disarticulation or hemipelvectomy managed with continuous anterior QLB in conjunction with general anesthesia and regional anesthesia. All of the four patients received a bolus of 20 ml of 0.2 ropivacaine or 0.25% bupivacaine with epinephrine (1:400,000) at the plane between quadratus lumborum and psoas major. This is followed by continuous infusion of 0.125–0.2% bupivacaine or ropivacaine via patient-controlled analgesia (PCA) at 3–5 ml/h for 3–5 days. Supplementary pain medications include tramadol, gabapentin, and non-steroidal inflammatory drugs. Pain scores ranged from 0–3/10 at rest and 4–6/10 with movement. None of the patients required additional systemic opioids beyond low-dose tramadol or morphine. Phantom limb sensations were observed but were not associated with distress nor significant pain. No block-related complications were noted.Results Cadaveric and clinical studies have demonstrated that anterior QLB may achieve spread to the lumbar plexus (L1— L3), involving femoral, lateral femoral cutaneous, iliohypogastric, and ilioinguinal nerves. Compared to neuraxial or lumbar plexus blocks, anterior QLB avoids deep vascular plexuses and carries a lower risk of hematoma, making it a safer option in patients at risk of bleeding. The QL block is unlikely to provide surgical anesthesia or complete regional analgesia for hip surgery as this would require lumbar and sacral plexus blockade.Abstract P210 Figure 1Preoperative photo of patient C showing a 54 x 37 x 29 cm firm mass spanning the whole thigh and knee with engorged vessels and bullae with serous dischargeAbstract P210 Figure 2Gross specimen of the amputated right lower extremity from patient A, showing a 67 cm hard, non-tender mass on the posterior aspect of the knee with a fungating component. Hip disarticulation was performed due to impending tumor-related bleed, extensive soft tissue involvement, and pain limiting functionAbstract P210 Figure 3Postoperative image showing the placement of the continuous anterior quadratus lumborum (QL) catheter in patient CConclusions Continuous anterior QLB may serve as a valuable alternative when neuraxial or deep plexus blocks are contraindicated among patients undergoing major proximal lower limb amputation. Its efficacy needs to be confirmed in adequately powered, well-designed, prospective randomized-controlled trials.",
  "authors": [
    {
      "affiliations": [
        "Department of Anesthesiology, University of the Philippines – Philippine General Hospital, Manilla, Philippines"
      ],
      "name": "Danya Chan"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, University of the Philippines – Philippine General Hospital, Manilla, Philippines"
      ],
      "name": "Lina May Osit"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, University of the Philippines – Philippine General Hospital, Manilla, Philippines"
      ],
      "name": "Peñafrancia Cano"
    }
  ],
  "title": "P210 Optimizing postoperative analgesia in hemipelvectomy and hip disarticulation with continuous anterior quadratus lumborum block: a case series",
  "uid": "247eb8b2-a9f2-5d62-a2f7-e456ae1232bd"
}