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  • Comparison of lateral quadratus lumborum and lumbar plexus blocks for postoperative analgesia following total hip arthroplasty: a randomized clinical trial

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Original research
Comparison of lateral quadratus lumborum and lumbar plexus blocks for postoperative analgesia following total hip arthroplasty: a randomized clinical trial
  1. Tara Kelly1,
  2. Christopher D Wolla1,
  3. Bethany J Wolf2,
  4. Ellen Hay1,
  5. Sarah Babb3 and
  6. Sylvia H Wilson1
  1. 1Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
  3. 3College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Sylvia H Wilson, Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, USA; wilsosh{at}musc.edu

Abstract

Introduction Effective analgesia after total hip arthroplasty must minimize pain and optimize early ambulation. Lumbar plexus blocks (LPBs) provide analgesia but may cause motor weakness. Quadratus lumborum blocks (QLBs) may provide analgesia with preserved motor strength.

Methods This trial randomized subjects scheduled for elective hip arthroplasty to receive an LPB or lateral QLB for postoperative analgesia. The primary outcome was opioid consumption at 12-hour postoperative. Non-inferiority of lateral QLBs compared with LPBs was conducted using a one-sided two-sample t-test. Secondary outcomes included pain scores, cumulative opioid consumption, quadriceps strength, time to ambulation, and distance ambulated. Differences in pain scores and opioid consumption over time between groups were evaluated using a linear mixed model.

Results The trial consented and randomized 111 subjects and 103 completed the study: LPB (n=50) and lateral QLB (n=53). Mean (95% CI) cumulative opioid consumption (mg) at 12-hour postoperative was not found to be non-inferior in the lateral QLB (15.9 (12.7 to 19.2)) vs the LPB (12.7 (10.2 to 15.1)) group (p=0.625). Pain scores in postoperative anesthetic care unit (PACU) and 24-hour postoperative did not differ. The maximum distance ambulated did not differ, but lateral QLB patients were 2.4 times more likely to ambulate in the first 12 hours (p=0.024) and had significantly greater quadriceps strength in PACU (p<0.001).

Discussion Although we were unable to demonstrate non-inferiority for opioid consumption at 12-hour postoperative, strength and mobilization were improved in lateral QLB subjects.

Trial registration number NCT04402437.

  • Nerve Block
  • analgesia
  • Pain, Postoperative
  • Lower Extremity
  • Acute Pain

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information.

https://doi.org/10.1136/rapm-2022-103598

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    Data availability statement

    Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information.

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    Footnotes

    • Presented at This work has been accepted for presentation at The American Society of Regional Anesthesia and Pain Medicine 2022 Annual Meeting (Las Vegas, NV; Abstract #3127).

    • Contributors TK: This author helped with data collection, interpretation of the results, and manuscript writing and editing. CDW: This author helped with data collection, interpretation of the results, and manuscript writing and editing. ORCID 0000-0002-1309-5710. BJW: Conflicts of interest: none. This author helped with study design, data interpretation, statistical analysis, and manuscript writing and editing. ORCID 0000-0002-7124-5158. EH: This author helped with data collection, interpretation of the results, and manuscript writing and editing. SB: This author helped with data collection and manuscript writing and editing. SHW: This author helped with study conception, study procedures, interpretation of the results, manuscript writing and editing, and is the guarantor of the study.

    • Funding This work was supported by internal departmental support (Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina). This project was also supported by the South Carolina Clinical & Translational Research Institute, Medical University of South Carolina’s CTSA, NIH/NCRR Grant Number 1UL1TR001450.

    • Disclaimer The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NCRR.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.