Efficacy of Quadratus Lumborum Block for Pain Control in Patients Undergoing Hip Surgeries: A Systematic Review and Meta-Analysis

Abstract

BackgroundSeveral studies have reported the use of anterior, posterior and lateral quadratus lumborum block (QLB) for pain control in hip surgeries. However, high-quality evidence is lacking. The current review aimed to summarize data on the efficacy of QLB for pain control in patients undergoing hip surgeries.MethodsPubMed, Embase, and Google Scholar databases were searched up to August 5, 2021 for randomized controlled trials (RCTs) or non-RCTs assessing the efficacy of QLB for any type of hip surgery.ResultsThirteen studies were included (nine RCTs and four non-RCTs). On pooled analysis, there was a statistically significant reduction of 24-h total opioid consumption in patients receiving QLB as compared to the control group (MD: −9.92, 95% CI: −16.35, −3.48 I2 = 99% p = 0.003). We noted a statistically significant reduction of pain scores in the QLB group as compared to control group at 2–4 h (MD: −0.57, 95% CI: −0.98, −0.17 I2 = 61% p = 0.005), 6–8 h (MD: −1.45, 95% CI: −2.09, −0.81 I2 = 86% p < 0.00001), 12 h (MD: −1.12, 95% CI: −1.89, −0.34 I2 = 93% p = 0.005), 24 h (MD: −0.71, 95% CI: −1.27, −0.15 I2 = 89% p = 0.01) and 48 h (MD: −0.76, 95% CI: −1.37, −0.16 I2 = 85% p = 0.01) after the procedure. There was a statistically significant reduction in the risk of nausea/vomiting (RR: 0.40, 95% CI: 0.18, 0.88 I2 = 62% p = 0.02) in patients receiving QLB but no difference in the risk of pruritis (RR: 0.46, 95% CI: 0.17, 1.24 I2 = 16% p = 0.13) and urinary retention (RR: 0.44, 95% CI: 0.19, 1.02 I2 = 0% p = 0.06).ConclusionQLB as a part of a multimodal analgesic regimen reduces opioid consumption and pain scores in patients undergoing hip surgeries. The certainty of evidence based on GRADE was moderate. Despite the statistically significant results, the clinical relevance of the analgesic efficacy of QLB is debatable due to the small effect size.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42021267861.

Alte und neue Regionalanästhesieverfahren unter Review – Bauch bis Fußzehe

“…Wie bei allen interfaszialen Blockaden ist ein Erfolgselbst bei korrekter Ausbreitung des LAnicht sicher vorhersagbar. Trotz dieser Einschränkung zeigen fast alle randomisierten Studien eine effektive Schmerzunterdrückung für den AQLB von bis zu 48 h in der Hüftchirurgie, vergleichbar mit einer N.-femoralis-oder SIFI-Blockade [63,64,65]. Dagegen scheint die Quadrizepsschwäche weniger ausgeprägt.…”

Motor-sparing peripheral nerve blocks for hip and knee surgery

“…et al However, more recently, AQLB has increased popularity for use in THA [15][16][17][18]. In a meta-analysis of the efficacy of QLB for patients undergoing hip surgery, a significant reduction of 24 h total opioid utilization, reduced pain scores up to 48 h, and less postoperative nausea and vomiting was found in comparison to the control group [19]. However, the included studies did not analyze the effect of AQLB on ambulation or quadriceps strength.…”

Current Concepts in Postoperative Pain Management Surgeries of Hip Joint: A Narrative Review

“…Both transmuscular QLB and ESPB provide good postoperative pain control in hip surgeries, but QLB provides a better analgesic profile when compared to ESPB [34]. A recent systematic review and meta-analysis concluded that QLB reduced opioid consumption and pain scores in patients undergoing hip surgeries as a part of a multimodal analgesic regimen [35].…”