Posterior quadratus lumborum block for primary total hip arthroplasty analgesia: a comparative study

Abstract

Objective To compare analgesia and opioid consumption for patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block.Methods The medical records of patients undergoing unilateral total hip arthroplasty between January 1st, 2017 and March 31, 2018 were reviewed, and 238 patients were included in the study. The primary outcome was postoperative opioid consumption in the first 24 postoperative hours. Secondary outcomes were intraoperative, post anesthesia care unit, and 48-hour opioid consumption, postoperative pain Visual Analog Scale scores, and post-anesthesia care unit length of stay. Primary and secondary endpoint data were compared between patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block.Results For the patients who received quadratus lumborum block, the 24-hour total oral morphine equivalent (milligram) requirements were lower (53.82mg±37.41), compared to the patients who did not receive quadratus lumborum block (77.59mL±58.42), with p=0.0011. Opioid requirements were consistently lower for the patients who received quadratus lumborum block at each additional assessment time point up to 48 hours. Pain Visual Analog Scale scores were lower up to 12 hours after surgery for the patients who received a posterior quadratus lumborum block, and the post-anesthesia care unit length of stay was shorter for the patients who received quadratus lumborum block.Conclusion Preoperative posterior quadratus lumborum block for primary total hip arthroplasty is associated with decreased opioid requirements up to 48 hours, decreased Visual Analog Scale pain scores up to 12 hours, and shorter post-anesthesia care unit length of stay. Level of evidence: III

Posterior Quadratus Lumborum Block in Total Hip Arthroplasty: A Randomized Controlled Trial

“…Morphine consumption was chosen as the primary outcome, consistent with other studies on pain relief in total hip arthroplasty. [4][5][6]13,16 Secondary outcomes included intraoperative sufentanil consumption; morphine consumption in the postanesthesia care unit; area of cutaneous sensory loss sensation; pain scores at rest at extubation time and 2, 6, 12, and 24 h after extubation; pain scores during passive 90° hip flexion at 2, 6, and 24 h after extubation; maximal pain score during the intervals between extubation time and 2 h after extubation and between 2 and 24 h after extubation; motor blockade at 2 and 6 h after extubation; time to first standing and ambulation; hospital length of stay; and adverse events including block-related side effects. The sample size has been estimated a priori with calculation based on the anticipated opioid consumption difference between study groups.…”

A Comparative Analysis of the Quadratus Lumborum Block Versus Femoral Nerve and Fascia Iliaca Blocks in Hip Arthroscopy

“…A recent comparative study showed that hospital length of stay following total hip arthroplasty was found to be significantly decreased in patients receiving QL block compared with no block. 7 Kukreja et al 8,19 found in 2 separate studies that both the anterior and posterior QL block are effective at decreasing opioid requirements following hip arthroplasty in the first 48 hours postoperatively. A case report of the QL block used for 2 cases of femoral neck fracture and revision hip arthroplasty found it provided significant pain control without hip flexor or quadriceps weakness.…”

The effect of post-operative ultrasound-guided transmuscular quadratus lumborum block on post-operative analgesia after hip arthroplasty in elderly patients: A randomised controlled double-blind study

“…[ 28 ] They also revealed that the post-operative opioid requirement and the post-operative pain score were significantly decreased in patients undergoing primary total hip replacement under general or spinal anaesthesia if they received preoperative posterior QLB. [ 29 ] Furthermore, Green et al . evaluated the use of transmuscular QLB in patients undergoing hip surgeries.…”