No benefit of quadratus lumborum block addition for managing pain after hip surgery: Study
France: The addition of quadratus lumborum block to a multimodal analgesia regimen has no significant effect on morphine consumption and pain scores after total hip arthroplasty, according to a recent study in the journal Anesthesiology.
In patients who have undergone a hip replacement surgery, pain management becomes important to ensure early mobilization after the surgery; however, the optimal components remain controversial. Recent studies have advocated interfacial plane injections including quadratus lumborum block for pain relief after hip joint replacement. Considering the same, Philippe Biboulet, Lapeyronie University Hospital, France, and colleagues tested the hypothesis that the posterior quadratus lumborum block combined with multimodal analgesia decreases morphine consumption after hip arthroplasty.
For this purpose, the researchers performed a prospective, randomized, double-blind, placebo-controlled trial. The study included 100 participating patients scheduled for elective total hip arthroplasty. Before general anesthesia, they were randomly allocated to receive a 30-ml injection posterior to the quadratus lumborum muscle with either 0.33% ropivacaine (n = 50) or normal saline (n = 50).
For all patients, multimodal analgesia included systematic administration of acetaminophen, ketoprofen, and a morphine intravenous patient-controlled analgesia.
The primary outcome was total intravenous morphine consumption in the first 24 h. Secondary outcomes recorded intraoperative sufentanil consumption; morphine consumption in the postanesthesia care unit; pain scores at extubation and at 2, 6, 12, and 24 h; motor blockade; time to first standing and ambulation; hospital length of stay; and adverse events.
Key findings of the study include:
- There was no significant difference in the 24-h total morphine consumption (ropivacaine group, median, 13 versus saline group, 16 mg).
- Pain scores were not different between the groups (β = −0.4).
- There was no statistical difference between the two groups in intraoperative sufentanil consumption, morphine consumption in the postanesthesia care unit, motor blockade, times to first standing (median difference, 0.83 h) and ambulation (median difference, −1.85 h), hospital length of stay, and adverse events.
The study titled, "Posterior Quadratus Lumborum Block in Total Hip Arthroplasty: A Randomized Controlled Trial," is published in the journal Anesthesiology.