Dataset Information

Importance of quadratus lumborum muscle trigger point injection and prolotherapy technique for lower back and buttock pain.

ABSTRACT:

Background

Low back pain is a heterogeneous disease. Myofascial pain and enthesopathy of the quadratus lumborum muscle are important causes of lower back and/or buttock pain. However, a concrete, safe, and effective injection technique for the treatment of trigger points and enthesopathy in the quadratus lumborum muscle has not yet been developed.

Objectives

We aimed to evaluate the importance of the quadratus lumborum muscle and introduce an effective landmark-based blind injection technique for treating quadratus lumborum trigger points and enthesopathy.

Methods

Adult patients (n = 17) with lower back and/or buttock pain were placed in the lateral decubitus position. Next, we delicately palpated the quadratus lumborum muscle to accurately locate its lesions, including trigger points, taut bands, and tendon lesions, after five key landmarks had been identified. A newly designed 60-90-mm, 28G thin hypodermic needle was inserted at the tender points. The needle was typically advanced until its tip touched the transverse process to treat myofascial trigger points and tendon lesions in the iliolumbar and lumbocostal fibers, excluding superficial trigger points of the iliocostal fibers. Subsequently, lidocaine (0.5%) or a mixture of lidocaine (0.5%) and dextrose (12.5-15%) was injected.

Results

The pretreatment visual analog scale score for all 17 patients decreased from ≥4-8/10 (mean 5.588) to 0-1/10 (mean 0.294) after completion of all treatments. The total number of treatments was one to four in acute and subacute cases and two to eight in chronic cases. The mean follow-up period was 73.5 days (treatment period: range, 4 to 43 days + at least 60 days of follow-up).

Conclusions

Herein, we describe for the first time a landmark-based integrated injection technique for the treatment of trigger points and myofascial pain in the quadratus lumborum; this technique is safe, effective, and can be used with or without steroids, fluoroscopy, or ultrasound guidance.

SUBMITTER: Sirh SJ

PROVIDER: S-EPMC9723328 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Importance of quadratus lumborum muscle trigger point injection and prolotherapy technique for lower back and buttock pain.

Sirh Soo-Ji SJ Sirh So-Woon SW Mun Hah-Yong HY Sirh Heon-Man HM

Frontiers in pain research (Lausanne, Switzerland) 20221122

<h4>Background</h4>Low back pain is a heterogeneous disease. Myofascial pain and enthesopathy of the quadratus lumborum muscle are important causes of lower back and/or buttock pain. However, a concrete, safe, and effective injection technique for the treatment of trigger points and enthesopathy in the quadratus lumborum muscle has not yet been developed.<h4>Objectives</h4>We aimed to evaluate the importance of the quadratus lumborum muscle and introduce an effective landmark-based blind injecti ...[more]

PMID: 36483943

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Project description:BackgroundThe postoperative analgesic effect of transmuscular quadratus lumborum block (QLB-TM) in patients following lower abdominal surgeries has been identified; however, the efficacy of QLB using the lateral approach (QLB-L) is still in debate. Therefore, this retrospective study was conducted to investigate the effect of a single-shot block with QLB-L on postoperative analgesia for patients undergoing percutaneous nephrolithotomy (PCNL).MethodsThe medical information of the patients undergoing PCNL was retrieved from the electronic charter system (Medisystem, Suzhou, China) in our Nanjing Drum Tower Hospital during the period of Jan/2019 to Jun/2019. Among the total of 57 patients, there are 17, 18, and 22 patients subjected to QLB-L, QLB-TM, or routine treatment, respectively. The primary observational parameter was to assess postoperative pain with visual analog scales (VAS) at rest 30 min after extubation, 24 h, and 48 h after surgery, respectively. The secondary observatory endpoints, including the consumption of intraoperative opioids, the cumulative dose of non-steroid anti-inflammatory drugs (NSAIDs) and the incidence of adverse events related to postoperative analgesia, were evaluated as well.ResultsThe static VAS score at 24 h after surgery and the intraoperative consumption of sufentanil were significantly lower in patients receiving either intervention of QLB-L or QLB-TM as compared with those receiving routine treatment. However, one shot of QLB had no impact on VAS scores at 30 min post-extubation, 48 h after PCNL procedure compared with the patients receiving routine treatment. The percentage of non-ambulatory patients within 24 h post-PCNL was significantly higher in the QLB-TM group compared with the routine treatment group (P = 0.04). There were no significant differences in the incidence of postoperative nausea and vomit (PONV), itches, respiratory depression, the time for the first defecation, and the length of hospital stay (LOS) among the three groups.ConclusionsQLB-L procedure may exert as equivalent as QLB-TM in terms of abrogating postoperative pain within 24 h post-surgery and decreasing intraoperative sufentanil consumption in patients undergoing PCNL procedure as well. The caution should be taken to avoid lower extremities weakness in the patients after QLB-TM within the first 24 h post-PCNL procedure.

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Project description:ObjectiveAnterior quadratus lumborum block at the lateral supra-arcuate ligament (QLBA) is a new method for postoperative pain relief in patients undergoing abdominal surgery. Perioperative QLBA is effective, but it has not been compared with posterior quadratus lumborum block (QLB2). The present study aims to evaluate the postoperative pain of patients undergoing laparoscopic nephrectomy surgery with QLBA versus QLB2.Methods/designThis study is a randomised, prospective, parallel group, non-inferior trial. All patients undergoing laparoscopic nephrectomy surgery will be randomised 1:1 to the QLBA group or the QLB2 group with general anaesthesia. The objective of the trial is to evaluate the postoperative pain of patients undergoing laparoscopic nephrectomy surgery with QLBA (n=50) versus QLB2 (n=50). The primary outcome for this trial is the Visual Analogue Scale scores at rest and activity (dynamic pain scores are assessed with a cough or a trial to sit up in bed) 2 hours after surgery between patients who receive QLBA versus QLB2. The secondary objectives will be to compare (1) pain at rest and activity 0.5 hour, 2 hours, 24 hours, 48 hours after surgery; (2) the time spent on block operation; (3) the blocked dermatomal coverage 5 min and 15 min after block operation; (4) intraoperative opioid consumption; (5) types and doses of the rescue analgesic after surgery; (6) nausea and vomiting score within 24 hours after surgery; (7) time from the end of surgery to the first onset significant pain; (8) patient satisfaction score.DiscussionClinical experience has supported that QLB is a very effective postoperative analgesic method, and we will answer the following questions in this trial: Will both approaches have the same analgesic effect and duration? Will the QLBA have a non-inferior postoperative analgesic effect compared with QLB2 or the QLBA be able to prolong the duration of analgesia after surgery? The results of this study could have actual clinical applications that could help to reduce postoperative pain and shorten hospital stays.Ethics and disseminationThe study design was approved by the ethical committee of Beijing Chao-Yang Hospital, Beijing, China (2020-ke-321). The trial results will be published in peer-reviewed journals and at conferences.Trial registration numberChiCTR2000035354.

Dataset Information

Importance of quadratus lumborum muscle trigger point injection and prolotherapy technique for lower back and buttock pain.

Background

Objectives

Methods

Results

Conclusions

Publications

Importance of quadratus lumborum muscle trigger point injection and prolotherapy technique for lower back and buttock pain.

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