Ultrasound-Guided Transmuscular Quadratus Lumborum Block Reduces Postoperative Pain Intensity in Patients Undergoing Total Hip Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial

Abstract

Background and Objectives. Pain management following total hip arthroplasty (THA) has been widely investigated; however, the best effective method is yet to be determined. The aim of this prospective, placebo-controlled study was to evaluate the analgesic efficacy of ultrasound-guided QL3 block in patients undergoing THA. Methods. Eighty-eight patients undergoing THA were randomized to receive 0.33% ropivacaine (Group QLB, n = 44) or saline (Group Con, n = 44) for QL3 block. Spinal anesthesia was then performed. Pain intensity was assessed using the visual analog scale (0: no pain to 10: worst possible pain). The primary outcome was pain scores recorded at rest at 3, 6, 12, 24, 36, and 48 h and on standing and walking at 24, 36, and 48 h postoperatively. Secondary outcomes were analgesic consumption, side effects, the 10-meter walking speed on day 6, and patient satisfaction after surgery. Results. Postoperative pain intensity was significantly lower in Group QLB compared to Group Con at rest after 3, 6, 12, 24, 36, and 48 h (p<0.001) and during mobilization after 24, 36, and 48 h (p<0.001). Morphine use was significantly lower in Group QLB compared to Group Con during 0–24 h (16.0 ± 7.1 vs. 34.1 ± 7.1 mg, p<0.001) and during 24–48 h (13.0 ± 4.0 vs. 17.4 ± 4.6 mg, p<0.001) postoperatively. The 10-meter walking speed was higher in Group QLB compared to Group Con, both at comfortable (0.79 ± 0.13 vs. 0.70 ± 0.14 m/s, p=0.012) and at maximum speeds (1.18 ± 0.26 vs. 1.06 ± 0.22 m/s, p<0.001). Incidences of nausea (7.3% vs. 31%, p=0.006), vomiting (7.3% vs. 26.2%, p = 0.022), and urinary retention (9.8% vs. 28.6%, p=0.030) were lower in Group QLB than in Group Con. Conclusions. Ultrasound-guided QL3 block is an effective pain management technique after THA.

Retrospective study of quadratus lumborum block for postoperative analgesia in patients undergoing percutaneous nephrolithotomy

“…The weakness of lower extremities was identified in patients receiving QLB-TM. Previous studies indicated that the QLB-TM reduced postoperative 24 h pain scores and opiates consumption in patients after total hip arthroplasty [21]. The lower extremities weakness was accidentally reported in patients receiving QLB-TM [22].…”

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

“…Eighteen articles were selected for full-text analysis. Of them, thirteen studies fulfilled the inclusion criteria and were analyzed in this review (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33).…”

“…Details of the included studies are presented in Table 1. Nine (21,24,26,(28)(29)(30)(31)(32)(33) were RCTs while four (22,23,25,27) were retrospective studies. Most studies were carried out in the USA or China.…”

Randomized controlled trial of a quadratus lumborum block with liposomal bupivacaine for postoperative analgesia in laparoscopic donor nephrectomy

“…The quadratus lumborum (QL) block was first described in 2007, 6 and since has been used to reduce pain and narcotic use in a wide variety of surgeries including Cesarean section, hip arthroplasty, and laparotomy. 7 , 8 , 9 , 10 In laparoscopic donor nephrectomy, repeated QL block has shown comparable postoperative pain scores and sensory blockade to continuous epidural analgesia. 11 …”

“…The quadratus lumborum (QL) block was first described in 2007, 6 and since has been used to reduce pain and narcotic use in a wide variety of surgeries including Cesarean section, hip arthroplasty, and laparotomy. [7][8][9][10] In laparoscopic donor nephrectomy, repeated QL block has shown comparable postoperative pain scores and sensory blockade to continuous epidural analgesia. 11 We hypothesized that administering a long-acting bupivacaine transmuscular QL block could improve postoperative pain control and promote faster return to normal activities in patients undergoing laparoscopic donor nephrectomy at our institution.…”