Comparison of lateral quadratus lumborum and lumbar plexus blocks for postoperative analgesia following total hip arthroplasty: a randomized clinical trial

Abstract

IntroductionEffective analgesia after total hip arthroplasty must minimize pain and optimize early ambulation. Lumbar plexus blocks (LPBs) provide analgesia but may cause motor weakness. Quadratus lumborum blocks (QLBs) may provide analgesia with preserved motor strength.MethodsThis trial randomized subjects scheduled for elective hip arthroplasty to receive an LPB or lateral QLB for postoperative analgesia. The primary outcome was opioid consumption at 12-hour postoperative. Non-inferiority of lateral QLBs compared with LPBs was conducted using a one-sided two-sample t-test. Secondary outcomes included pain scores, cumulative opioid consumption, quadriceps strength, time to ambulation, and distance ambulated. Differences in pain scores and opioid consumption over time between groups were evaluated using a linear mixed model.ResultsThe trial consented and randomized 111 subjects and 103 completed the study: LPB (n=50) and lateral QLB (n=53). Mean (95% CI) cumulative opioid consumption (mg) at 12-hour postoperative was not found to be non-inferior in the lateral QLB (15.9 (12.7 to 19.2)) vs the LPB (12.7 (10.2 to 15.1)) group (p=0.625). Pain scores in postoperative anesthetic care unit (PACU) and 24-hour postoperative did not differ. The maximum distance ambulated did not differ, but lateral QLB patients were 2.4 times more likely to ambulate in the first 12 hours (p=0.024) and had significantly greater quadriceps strength in PACU (p<0.001).DiscussionAlthough we were unable to demonstrate non-inferiority for opioid consumption at 12-hour postoperative, strength and mobilization were improved in lateral QLB subjects.Trial registration numberNCT04402437.

Effects of anterior approach to quadratus lumborum block on postoperative cognitive function following hip surgery in elderly patients: A randomized controlled clinical trial

“…This indicated that adequate postoperative analgesia provided by QLB could promote early postoperative rehabilitation of patients, consistent with a previous study performed by Kelly et al. [27] . Hematoma and LAST are severe QLB-related complications.…”

Effects of anterior approach to quadratus lumborum block on postoperative cognitive function following hip surgery in older people: a randomized controlled clinical trial

“…Compared to the control group, the patients of the QLB group had a shorter time to first off-bed activity. This indicated that adequate postoperative analgesia provided by QLB could promote early postoperative rehabilitation of patients, consistent with a previous study performed by Kelly et al [ 26 ]. Hematoma and LAST are severe QLB-related complications.…”

Efficacy of Continuous Lumbar Plexus Blockade in Managing Post-Operative Pain after Hip or Femur Orthopedic Surgeries: A Systematic Review and Meta-Analysis

“…The controls employed several techniques, including fascia iliaca block (FIB), femoral nerve block (FNB), quadratus lumborum block (QLB), Supra-Inguinal Fascia Iliaca Block (SIFIB), Paravertebral Block (PVB), Lumbosacral Plexus Block (LSPB), Lumbar Erector Spinae Plane Block (LESPB), PCA (Patient-Controlled Analgesia), and PCEA (Patient-Controlled Epidural Analgesia). The sample sizes ranged from 34 to 225 with a total of 1687 patients, and the studies were conducted in seven countries, with the majority being in the USA; ten studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] were conducted in the USA, two [ 26 , 27 ] in Switzerland, two [ 28 , 29 ] in India, two [ 30 , 31 ] in China, two [ 32 , 33 ] in Serbia, one [ 34 ] in Chile, and one [ 15 ] in Egypt. The trials utilized pain scores, including VAS pain scores, NRS pain scores, and opioid consumption, as crucial outcome measures to examine the efficacy of analgesic interventions.…”