Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study

Abstract

Background and objectivesQuadratus lumborum (QL) block is a new regional analgesic technique for upper and lower abdominal surgeries as part of a multimodal analgesic regime. It has also been reported to relieve pain after total hip arthroplasty (THA). In this prospective, randomized, double-blind study, we compared QL block with control (no block) in patients undergoing primary THA.MethodsEighty patients undergoing primary THA surgery under spinal anesthesia were randomized into two groups, one with and one without QL block. The patients in both groups were randomized after sedation, positioning and ultrasound scanning. Both the patient and the researcher collecting data were blinded to the patient’s group assignment. Opioid consumption and visual analog scores (VAS) pain scores were measured at 12, 24, and 48 hours after surgery. Also, the ambulation distance, patient satisfaction, and length of stay were recorded.ResultsThe study analysis included 36 patients in the QL group and 35 patients in the control group. Both VAS pain score at 24 hours (difference −1.76, 95% CI −2.87 to −0.64) and cumulative opioid consumption were significantly lower in the QL group at 12, 12–24, 24, 24–48, and 48 hours after surgery as compared with the control group (difference at 48 hours −36.13, 95% CI −62.89 to −9.37) (p<0.05). However, there was no difference in pain score at 12 and 48 hours, nor in the ambulation distance and duration of hospital stay between the two groups. The patient satisfaction score was significantly higher in the QL group.ConclusionsOur preliminary data show that the QL block provided effective analgesia and decreased opioid requirements up to 48 hours after primary THA.Trial registration numberNCT03408483

Anesthetic management using a combination of anterior quadratus lumborum block and erector spinae plane block for robot-assisted partial nephrectomy: two case reports

“…QLB are classified into three main types: posterior, lateral, and anterior approach [12]. The anterior QLB has been reported to have great efficacy in hip surgery and lower abdominal surgery [1][2][3]. Recent studies have shown that the anterior QLB is suitable for flank surgery rather than abdominal surgery with a midline incision [4,5,13].…”

“…Based on increasing studies regarding the mechanism and efficacy of quadratus lumborum block (QLB), QLB is considered suitable for lower abdominal surgery and hip surgery [1][2][3]. However, attention should be paid to the indications for abdominal surgery since Tamura et al suggested that QLB (posterior and intramuscular) efficacy may be limited to the lateral abdominal region [4,5].…”

Ultrasound-guided Quadratus Lumborum Block for Perioperative Analgesia in Robot-assisted Partial Nephrectomy: A Randomized Controlled Trial

“…However, opioid consumption was similar in both groups during the first 24 hours after surgery. Kukreja et al [29]have also demonstrated the benefits of opioid-sparing analgesic effect of the anterior quadratus lumborum block in total hip arthroplasty. The true mechanism of action of the QLB is not completely known.…”

“…Ultrasound-guided QLB technique was first described by Blanco [11,12], and the benefits of QLB for postoperative pain relief and opioids-sparing effect have been reported by several randomized controlled trials and case reports [2,5,6,[8][9][10][19][20][21][22][23][24][25][26][27][28][29][30]. All approaches have been proved the synergistic efficacy for multimode analgesia, especially for QLB2 or QLB3 after laparoscopic surgery, cesarean section and total hip arthroplasty.…”

A Retrospective Case Series of Pericapsular Nerve Group (PENG) Block for Primary Versus Revision Total Hip Arthroplasty Analgesia

“…Fascia iliaca compartment block (FICB) has not been found to predictably decrease pain intensity or opioid use [8]. Quadratus lumborum (QL) block is a relatively new regional block found to provide effective analgesia after primary THA, but it can indirectly block lumbar plexus branches and may cause some motor weakness [9]. It is also a deep block and therefore contraindicated in patients on anticoagulation [10].…”