Analgesic benefits of the quadratus lumborum block in total hip arthroplasty: a systematic review and meta‐analysis

Abstract

Summary The quadratus lumborum block (QLB) is reported to reduce pain and improve function following total hip arthroplasty; however, randomised controlled trials evaluating the benefits of adding this block to general or spinal anaesthesia in this population are conflicting. We performed a systematic review seeking randomised controlled trials investigating QLB benefits for total hip arthroplasty, stratifying comparisons regarding the addition of QLB to either general or spinal anaesthesia. The primary outcome was 24‐h area under the curve (AUC) pain score. Pain scores were interpreted in the context of a population‐specific minimal clinically important difference of 1.86 cm on a 10‐cm visual analogue scale, or an AUC pain score of 5.58 cm.h. Secondary outcomes included analgesic consumption, functional recovery and opioid‐related side‐effects. In all, 18 trials (1318 patients) were included. Adding QLB to general or spinal anaesthesia improved 24‐h AUC rest pain scores by a mean difference (95%CI) of −3.56 cm.h (−6.70 to −0.42; p = 0.034) and − 4.19 cm.h (−7.20 to −1.18; p = 0.014), respectively. These improvements failed to reach the pre‐determined minimal clinically important difference, as did the reduction in analgesic consumption. Quadratus lumborum block improved functional recovery for general, but not spinal, anaesthesia. Opioid‐related side‐effects were reduced with QLB regardless of anaesthetic modality. Low‐to‐moderate quality evidence suggests that the extent to which adding QLB to either general or spinal anaesthesia reduces postoperative pain and opioid consumption after total hip arthroplasty is statistically significant but may be clinically unimportant for most patients. However, adding QLB to general anaesthesia might enhance functional recovery. Taken together, our findings do not support the routine use of QLB as part of multimodal analgesic regimens for total hip arthroplasty.

Comparison of Pericapsular Nerve Group (PENG) Block Versus Quadratus Lumborum (QL) Block for Analgesia After Primary Total Hip Arthroplasty Under Spinal Anesthesia: A Retrospective Study

“…It is important to note that those in the QL block group showed trends of less OME usage and lower VAS scores compared to the PENG group. This can be explained by the broader dermatonmal coverage achieved with QL blocks compared to PENG [ 8 ]. Our study also found no statistically significant difference in ambulation distances at 24 and 48 hours between block and control, which could imply that the block patients had equal ability to participate in physical therapy as those who received no block.…”

Anterior Quadratus Lumborum block area comparison in the three different volumes of Ropivacaine: a double-blind, randomized controlled trial in healthy volunteers

“…As QLB is a fascial plane block, high-volume regional anesthesia would result in the broad spread of local anesthetic in the interfascial plane, but not with a longer effective time. Ropivacaine 0.375% is a commonly selected concentration in QLB for postoperative analgesia in recent studies [ 23 ], and thus serves as a reference concentration.…”

“…As QLB is a fascial plane block, highvolume regional anesthesia would result in the broad spread of local anesthetic in the interfascial plane, but not with a longer effective time. Ropivacaine 0.375% is a commonly selected concentration in QLB for postoperative analgesia in recent studies [23], and thus serves as a reference concentration. Christian et al injected 30 mL of 0.375% ropivacaine bilaterally (60 mL in total) in the fascial interspace of quadratus lumborum and psoas major muscle without any local anesthetic toxicity symptoms [24].…”

Ultrasound-guided quadratus lumborum block: a powerful way for reducing postoperative pain

“…The findings from a meta-analysis indicate that the use of QLB has the potential to decrease postoperative pain and the need for opioid medication in individuals undergoing total hip joint replacement surgery who receive general anaesthesia or spinal anaesthesia 20 . Cadaveric specimens studies have found that QLB3 is different from QLB1 and QLB2, with a more consistent spread of the dye in different specimens, reaching the L1 to L3 nerve roots within the QL and the PM 18 .…”