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Abstract
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Background and Aims Total hip arthroplasty (THA) is a frequent orthopedic procedure, leading to substantial perioperative pain. Suprainguinal fascia iliaca block (SIFIB) and anterior quadratus lumborum block (A-QLB) are two modern regional anesthesia methods used for THA analgesia. This study compares their efficacy in THA via a posterior approach.
Methods This randomized, assessor blinded study was conducted between January 2023 and May 2024 following IRB approval and registration (NCT05684471). ASA I-III patients aged 18-75y scheduled for THA were included. Blocks were performedat the end of surgery with 50 mL of 0.25% bupivacaine in the SIFIB group, and with 40 mL of 0.25% bupivacaine in the A-QLB group. The primary outcome assessed was the 24-hour cumulative morphine requirement, delivered via patient-controlled analgesia (PCA). Secondary outcomes encompassed pain scores, time to first opioid demand, and presence of quadriceps weakness. Additionally, occurrences of nausea, vomiting, and Quality of Recovery-15 (QoR-15) scores were recorded.
Results In this study of 65 patients (SIFIB: 33, A-QLB: 32), morphine consumption at various time points showed no difference between groups (p>0.05). At 24 hours, opioid usage was similar (SIFIB: 9.94±7.64 mg, A-QLB: 11.31±6.85 mg, p: 0.449). Pain scores, time to first analgesic requirement, and QoR scores were comparable (p>0.05). Notably, quadriceps weakness varied, with the SIFIB group having an 18/15 absence/presence ratio and the A-QLB group a 25/7 ratio by 24 hours post-op.
Demonstration of cumulative morphine requirement (mg) by groups over time
Comparison of descriptive and postoperative analgesia related data. Descriptive data, QoR-15 scores are expressed as mean±standard deviation or patient number. Data related to NRS and analgesic requirements are expressed as median (percentiles 25–75). p values were italicized and p values that are written in bold represent statistical significance
Conclusions Although opioid demands and pain scores showed no significant differences among patients undergoing THA with either SIFIB or A-QLB for postoperative pain relief, A-QLB demonstrated superior motor sparing effects.