Ultrasound-Guided Anterior Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Related Side Effects in Patients Undergoing Total Hip Replacement Arthroplasty: A Propensity Score-Matched Cohort Study

Abstract

Quadratus lumborum block (QLB) has been shown to be effective for pain relief after hip surgery. This study evaluated the efficacy of ultrasound-guided anterior QLB in pain control after total replacement hip arthroplasty (TRHA). A total of 115 patients receiving anterior QLB were propensity score-matched with 115 patients who did not receive the block. The primary outcome was opioid consumption at 24, 24-48, and 48 postoperative hours. Secondary outcomes included pain scores at the post-anesthesia care unit (PACU), 8, 16, 24, 32, 40, and 48 h length of hospital stay, time to first ambulation, and the incidence of opioid-related side effects. Postoperative opioid consumption 48 h after surgery was significantly lower in the QLB group. Resting, mean, worst, and the difference of resting pain scores compared with preoperative values were significantly lower in the QLB group during the 48 postoperative hours. The length of hospital stay was shorter in the QLB group. The incidence of postoperative nausea and vomiting was significantly lower in the QLB group during the 48 postoperative hours, except at the PACU. This study suggests that anterior QLB provides effective postoperative analgesia for patients undergoing THRA performed using the posterolateral approach.

Keywords: pain; quadratus lumborum block; total hip arthroplasty; ultrasound-guided.

Figure 1

Schematic illustration of the procedure of QLB. (A) The Shamrock sign; (B) ultrasound image of anterior QLB with displaying needle trajectory (white arrows display needle trajectory). QLM, quadratus lumborum muscle; PM, psoas muscle; TP, transverse process; ESM, erector spinae muscle; VB, vertebral body.

Figure 2

Flow chart of patient selection and propensity score-matching. QLB, quadratus lumborum block; PCA, patient-controlled analgesia; IV, intravenous.

Figure 3

Postoperative opioid consumption during the 48 h postoperative period between the QLB and control group. Values are mean ± SD. * p < 0.05 QLB, quadratus lumborum block.

Figure 4

Comparison of pain intensity in the PACU at 8, 16, 24, 32, 40, and 48 h after surgery between QLB and Control groups. Values are mean ± SD. * p < 0.05 PACU, post-anesthesia care unit; NRS, numeral rating scale; QLB, quadratus lumborum block.