Postoperative pain treatment with transmuscular quadratus lumborum block and fascia iliaca compartment block in patients undergoing total hip arthroplasty: a randomized controlled trial

Qin Xia, Wenping Ding, Chao Lin, Jiayi Xia, Yahui Xu, Mengxing Jia, Qin Xia, Wenping Ding, Chao Lin, Jiayi Xia, Yahui Xu, Mengxing Jia

Abstract

Background: Patients often suffer moderate or even severe pain after total hip arthroplasty; such pain seriously affects early postoperative recovery. This study aimed to investigate the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block combined with fascia iliaca compartment block for elderly patients undergoing total hip arthroplasty.

Methods: Fifty-four patients scheduled for total hip arthroplasty were included in this randomized controlled study. The patients were randomly assigned to receive only transmuscular quadratus lumborum block (group Q) or transmuscular quadratus lumborum block combined with fascia iliaca compartment block (group QF) with ultrasound guidance. Postoperatively in both groups, paracetamol 1 g was regularly administered at 6 h intervals and patient-controlled intravenous analgesia was administered. The primary outcome was cumulative sufentanil consumption via patient-controlled intravenous analgesia 24 h postoperatively. The secondary outcomes included pain degree, time to the first analgesic requirement, joint range of motion, quality of recovery, and the incidence of postoperative complications.

Results: Fifty patients were included, and their data were analyzed. The cumulative sufentanil consumption in group QF was significantly lower during the first 24 h after surgery than that in group Q, and the cumulative sufentanil consumption in group QF was reduced at 6-12 and 12-18 h after surgery. The postoperative pain intensity was lower in group QF than in group Q (linear mixed-effects model, the main effect of treatment: P < 0.001). Compared with group Q, group QF had higher quality of recovery and joint range of movement. The time to the first analgesic requirement was longer in group QF than in group Q (log-rank, P < 0.001). There was no statistically significant difference in complications postoperatively between the two groups.

Conclusions: Our study provides a multimodal, opioid-sparing analgesic regimen for elderly patients undergoing total hip arthroplasty. The combination of transmuscular quadratus lumborum block and fascia iliaca compartment block provides a significant advantage for early postoperative functional recovery. Further studies are required to confirm the minimum effective dose.

Trial registration: The study was registered on the 21st December 2020 (retrospectively registered) on the Chinese Clinical Trial Registry: ChiCTR2000038686 .

Keywords: Fascia iliaca compartment block; Multimodal analgesia; Total hip arthroplasty; Transmuscular quadratus lumborum block.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
A: Posture and injection approach of transmuscular quadratus lumborum block; B: Ultrasound image of transmuscular quadratus lumborum block. Solid arrow indicates needle trajectory and injection point between QLM (quadratus lumborum muscle) and PM (psoas major muscles); dashed line indicates the spread of the LA (local anesthetic); blue:local anesthetic; ESM: erector spinae muscle; TP: transverse process
Fig. 2
Fig. 2
A: Posture and injection approach of fascia iliaca compartment block; B: Ultrasound image of fascia iliaca compartment block. Solid arrow indicates needle trajectory and injection point between fascia iliaca and iliac muscle (IM); dashed line indicates the spread of the LA (local anesthetic); blue:local anesthetic; ASIS, anterior superior iliac spine; PM, psoas major muscles
Fig. 3
Fig. 3
Consolidated Standards of Reporting Trials (CONSORT) flow diagram
Fig. 4
Fig. 4
Numeric Rating Scores at rest (left) and during movement (right). NRS, numeric rating scores. Data are expressed as median and interquartile range. *: P < 0.05
Fig. 5
Fig. 5
Kaplan–Meier curves for time to first opioid request
Fig. 6
Fig. 6
The maximum flexion (left) and abduction (right) ROM of the hip joint at 12 h, 24 h, 48 h and 72 h after surgery. ROM, range of movement. Data are expressed as mean ± SD. *: P < 0.05

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