No Clinical Analgesic Effect From Quadratus Lumborum Block for Total Hip Arthroplasty

Ultrasound-guided single-shot quadratus lumborum block (QLB) did not lead to a significant analgesic effect in patients who received total hip arthroplasty (THA), according to research published in Pain Medicine.

Investigators from the All India Institute of Medical Sciences searched publication databases through April 2021 for studies of QLB analgesic in the THA setting. Pain-related outcomes and opioid consumption were assessed.

This review comprised 7 randomized controlled studies, 2 retrospective studies, and 1 controlled clinical study. There were 774 patients who underwent THA, 346 of whom received QLB and 428 of whom received no block, sham block, or other nerve block.

QLB was associated with significantly less pain (weighted mean difference [WMD], -0.62; 95% CI, -1.15 to -0.10; P =.02; I², 75%). However, the reduction in the visual analog score at rest did not reach the minimal clinically important difference (<1.5 cm) on a 10 cm scale. Pain on movement was similar between patients who received QLB and control participants (WMD, -1.52; 95% CI, -3.34 to 0.30; P =.10; I², 96%).

Patients who received QLB did not consume less opioids than the control cohort (WMD, -4.09; 95% CI, -9.00 to 0.83; P =.10; I², 95%). The time to first request for analgesia did not differ between groups (WMD, -0.24; 95% CI, -3.39 to 2.90; P =.88; I², 52%).

There was evidence to support QLB for reducing postoperative nausea and vomiting (risk ratio [RR], 0.33; 95% CI, 0.20-0.56; P <.0001; I², 0%).

The analysis was limited by the few available randomized trials in the literature and the heterogenous designs in the underlying studies.

The study authors concluded that this systematic review and meta-analysis did not identify any clinically significant reduction in pain-related outcomes or opioid consumption from QLB in the setting of THA. However, there was a high level of uncertainty of these findings, making it difficult to make informed clinical decisions on the basis of these data.

“As the number of THA performed worldwide increases, it becomes important to identify the perioperative strategies that result in effective postoperative analgesia and other clinically meaningful outcomes,” the study authors noted.

Reference

Behera BK, Misra S, Sarkar S, Mishra N. A systematic review and meta-analysis of efficacy of ultrasound-guided single-shot quadratus lumborum block for postoperative analgesia in adults following total hip arthroplasty. Pain Med. Published online January 4, 2022. doi:10.1093/pm/pnab353