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Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study
  1. Promil Kukreja1,
  2. Lisa MacBeth1,
  3. Adam Sturdivant1,
  4. Charity J Morgan2,
  5. Elie Ghanem3,
  6. Hari Kalagara1 and
  7. Vincent W S Chan4
  1. 1Department of Anesthesiology and Perioperative Medicine, UAB, Birmingham, Alabama, USA
  2. 2Department of Biostatistics, UAB, Birmingham, Alabama, USA
  3. 3Department of Orthopaedics Surgery, UAB, Birmingham, Alabama, USA
  4. 4Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Promil Kukreja, Anesthesiology and Perioperative Medicine, UAB, Birmingham, AL 35249, USA; pkukreja{at}uabmc.edu

Abstract

Background and objectives Quadratus 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.

Methods Eighty 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.

Results The 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.

Conclusions Our preliminary data show that the QL block provided effective analgesia and decreased opioid requirements up to 48 hours after primary THA.

Trial registration number NCT03408483

  • quadratus lumborum block
  • regional anesthesia
  • analgesia
  • postoperative pain
  • total hip arthroplasty
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Footnotes

  • Contributors PK, LM, EG, HK, and VWSC contributed to the study design. PK, LM, and HK recruited study patients after randomization. AS collected study data. CJM contributed to statistical analysis. PK, LM, HK, and VWSC drafted the manuscript. All the authors reviewed and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study got ethical approval from the Institutional Review Board of the University of Alabama at Birmingham.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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